From the horse's mouth: an interview with a doc attending the Texas Ebola patients.

[mnhtnbb]

And yes, the nurses and rest of the team were VOLUNTEERS.

Dr. Weinstein was at the heart of the care team at Presbyterian and treated all three Ebola patients who contracted the virus in the U.S., Thomas Eric Duncan, Nina Pham, and Amber Vinson.

St. James: What risk category do you think you're in?

Dr. Weinstein: I think I would be […] according to their stratification, I think I would be low-to-no apparent risk. I think I'm no apparent risk because I've had exposure to the patients, but I have not had any exposures to bodily fluids when I have not been completely, completely covered.

St. James: I think the public would dispute that. Should you not be high risk?

Dr. Weinstein: My only interactions with any of these patients have been in completely covered respirators, no skin showing to the outside world. The exact same personal protection equipment [PPE] that they're using today at the NIH and at Emory Hospital.

St. James:So, you consider yourself to be low risk.

Dr. Weinstein: At most. I think I'm no risk.

<snip>

Dr. Weinstein: The nurses volunteered. We had an amazing, unbelievable team of nurses and respiratory therapists, and housekeepers, and everybody that's involved in the care of a patient, pharmacists – [an] unbelievable team of people who have poured their hearts out for the last 19 days.

St. James: Why did they volunteer?

Dr. Weinstein: Nobody questioned it. It's been so heartwarming. This kind of illness, this process that we've been through, this is the essence of nursing. This is the epitome of health care.

Somebody is sick and needs help, and we provided the help that they needed. This is what we do. Nobody said no.

<snip>

St. James: What sort of protective gear were you wearing?

Dr. Weinstein: When I was involved, everyone on the team was doing the same exact thing. Everyone had on full protective gear, so you had on multiple sets of gloves, impermeable, water-impervious zippered jumpsuit, […] gloves taped to the sleeves, […] multiple pairs of liquid-impervious booties, […]masks, and a full, completely-covered headgear that had a source of air that you wore on a belt that's behind you, that's filtered.

Nothing exposed. Completely covered.

St. James: Did you ever hear any complaints from nurses about adequate protection?

Dr. Weinstein: did not. What we asked for, we got. We had complete support. And again, I think we're learning about this. This is the first time in this country that a patient with Ebola has presented to an emergency room to be diagnosed. And there's a big difference between a patient with a known diagnoses, and people coming to the door of our emergency room who are ill, who might have Ebola.

St. James: Did you feel like you had all the equipment you needed?

Dr. Weinstein: Again, I would say yes. And everything that we asked for that the CDC said, "You know, I think we ought to do this." We got it.

<snip>

St. James: So how do you think [she was infected?]

Dr. Weinstein: I think that these two nurses took care of a critically-ill patient at a time when he was not in control of his body fluids, and at a time when the recommendations from the CDC that we were following did not include the full respiratory mask.

I don't know that. But that's what one person thinks – that's me.

That's not based in science, it's not based on anything I saw. It's just trying to be thoughtful and think about the risks that we now know.

http://www.wfaa.com/story/news/health/2014/10/18/texas-health-presbyterian-doctor-talks-about-ebola-response/17483917/

[Bluenorthwest]

1. The author makes an error very early on...

He says 'treated all three Ebola patients who contracted the virus in the U.S., Thomas Eric Duncan, Nina Pham, and Amber Vinson.' But of course Duncan did not contract the virus in the U.S. The distinction is important. The issue is important and should be written about with full attention to accuracy.

[mnhtnbb]

3. There you go. The media doesn't get facts straight. The media.

[Fred Sanders]

4. All three were symptomatic in America, and two of the three were infected here. Minor in

comparison to all the erroneous media medical coverage.
And three is not how "epidemic" is defined, unless it is an epidemic of fear only, which it is.

[Bluenorthwest]

5. The point is that it IS erroneous media coverage.

If you are against bullshit errors in the media, you have to be against them all. Duncan did not contract Ebola in the US. That is an error at the outset of what should be an error free story.
That's how rumors are born. It is not acceptable to apply mediocre standards while taking up serious public health issues. I've been to this virus panic sideshow before. None of this is new to me.

[Yo_Mama]

2. I think his risk assessment is accurate, but it doesn't match with CDC's recs or risks

Nor do all or perhaps most hospitals have the equipment he used, much less is it available to ER personnel who would have to evaluate and treat a suspected Ebola case who came in very sick - vomiting, with the acute gastro symptoms, or bleeding.

So now what? Because CDC's entire plan involves the use of much lower levels of PPE for screening, evaluation and initial treatment of these patients, and I think we cannot now assume that CDC's plan doesn't involve a significant risk of transmission to HCW, which is what is happening in Africa.

We need a different protocol in place, and we need it swiftly.

Very few people go to the ER unless they feel they are getting acutely ill, and if they are not pretty sick on contact, unless they report a high level of risk they won't be tested anyway.

If we handle four cases of infection this year in ER's, what's the probability of transmissions from those intakes at the original hospitals? Don't we need a protocol to handle that risk, and remove potentially exposed HCW from patient care? Don't we need a testing/screening protocol for those workers?

To control the risks, we need to look at what has happened in Africa, where the disease spreads very swiftly through the health care system. Our first real life experience shows that it could work the same way here. If we ever get low-level community transition, we're sunk, because some of these cases remain subclinical, so you are never going to detect them or suspect them clinically, and then they may transmit the disease when they seek routine health care.

[librechik]

6. This is as good as it gets anywhere as far as protection goes

There isn't anything better. If you can think of better protection methods, step up.

The thing is, there is still a risk. Not so much for the doctor, he's an executive and rarely touches the patients. Sure he's zero-none.

We need safer ways to dispose of fluids, to wash the patient, to remove protective gear. We need 2-3 person nursing teams, who watch each other's movements.

Hospitals have been handling isolation patients for over a century. They've evolved methods and they work okay. I hope there are much smarter people than me working to sharpen the methods.

I'm afraid the millennials are going to get a taste of the 20th century.