Merged So Ebola's back......

[jimbob]

Partial derail, but xjx388, under your preferred totally free-market healthcare system what would have been the encouragement for a hospital to treat a suspected ebola case rather than pass them along to another hospital?

 

[jimbob]

http://news.sciencemag.org/health/2...s-wed-cdc-tell-us-about-first-u-s-ebola?rss=1

 

[xjx388]

Partial derail, but xjx388, under your preferred totally free-market healthcare system what would have been the encouragement for a hospital to treat a suspected ebola case rather than pass them along to another hospital?

The encouragement would be 1)the recognition for successfully treating the first U.S. Ebola case 2) the negative publicity that would ensue from declining treatment and 3) the ethical obligation as a medical provider to isolate and treat such a dangerous disease.

Under a free market system, we can still have a CDC whose job it would be to support the hospitals/doctors for big public threats like this.

And for the record, I'm not for a totally free system. I support licensing and education requirements, for example.

 

[rocketdodger]

I work only 2 miles from that hospital ( where I'm typing this ) and my kid was born there.

Pretty freaking scary HOWEVER if it starts to even marginally spread my opinion is that there will be some level of protection available very soon.

Can you imagine how much $$$ there would be in an Ebola vaccine, in a market like the Dallas metro area? That's one good thing about the free market I guess.

 

[Skeptic Ginger]

1) The ebola vaccines ready for human distribution: what do you know, the money comes from public funding in the form of the CDC guaranteed market. So one can get plenty of free market innovation even with public health insurance.

2) All the idiots on the news discussing the potentially exposed airline passengers haven't asked the most basic question, weren't many of them more exposed in the country they flew out of than on the plane?

3) Who's throwing the nurses under the bus, saying they did ask about travel history in the first ED visit but "the information wasn't passed on to the doctors"? Really? What, they didn't spoon feed it to the doctors? Failed to highlight it in the notes? Did they seriously ask then not write the answer on the chart? The last one is remotely possible but this looks like a bunch of crap with the hospital not stating the obvious, the nurses did a proper triage, the doctor missed it!

The nurses asked, the doctors not only failed to notice the answer, it's standard practice for the health care provider to ask the patient the same history questions the triage nurse would have asked. You always ask the patient important questions more than once, as they tend to answer differently when more details are elicited.

 

[Skeptic Ginger]

Ebola research funding:

http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-experimental-treatments.html

Is the U.S. government involved in the development of ZMapp?
The U.S. government, specifically, the NIH's National Institute of Allergy and Infectious Diseases, the Department of Defense's Defense Threat Reduction Agency (DTRA), and the HHS' Biomedical Advanced Research and Development Authority (BARDA), has provided support for the development of this experimental treatment.

Are there other companies developing experimental treatments or vaccines?
Two other companies, Tekmira and Biocryst Pharmaceuticals, receive funding from the Department of Defense's Defense Threat Reduction Agency and have therapeutic candidates for Ebola in early development. The Department of Defense is working with a company called Newlink to develop an Ebola vaccine candidate. BioCryst, with NIH support, is working to develop an antiviral drug to treat Ebola virus that is expected to begin Phase 1 testing later this year.

http://www.vox.com/2014/7/31/5952665/ebola-virus-vaccine-why-hasnt-it-happened

DB: The research has been almost exclusively through the National Institutes of Health. I think a lot of that has been driven by our country's concern over bioterrorism, and the use of some viruses as weapons. I'm not saying that's not one legitimate reason to do research, but just that its a different driving force.

 

[Skeptic Ginger]

http://news.sciencemag.org/health/2...s-wed-cdc-tell-us-about-first-u-s-ebola?rss=1

I can answer most of those:

Q: Dr. Frieden, it sounds like the patient wasn't tested for Ebola when he first sought medical care, on 26 September, even though he had just arrived from a country with an Ebola epidemic. Why not? Did the health care provider who saw him know he had arrived from Liberia 6 days earlier?

It looks like the doctor missed it.

Q: How many health care workers and how many others came into contact with the patient before he was isolated?

That would depend on the ED's practices, hopefully none or very few. The EMS workers did apparently follow proper isolation protocols. No doubt they are off work because fear is high and EMS workers live in crew quarters, a higher exposure risk than just at the worksite. I think they are being very prudent keeping these guys home.

Q: You said the patient's contacts are now being monitored. Can you give some details about this? Does it include going to their homes and taking their temperature daily? Or do you communicate with them by electronic means, such as phone calls, text messages, and e-mails?

I'm going to guess the CDC has sent in federal public health workers who are making home visits, perhaps daily. That's usually a judgement call if you think the exposed people are cooperating or might not.

News says five kids in the house are being kept out of school. Given there are five kids involved, the CDC is likely more involved keeping them quarantined.

Q: Are contacts being told to isolate themselves from their friends and family while they are being monitored?

That's a given.

Q: Does the government have any legal authority to force potential contacts to cooperate if they don't want to? Are they free to travel?

Yes. It's rarely used, public health officials are NOT the policing type. But when someone who poses a public risk doesn't comply, the law provides for enforced quarantine. But the jails aren't public health minded so there are issues all the way around with mandatory quarantine.

Q: Has the house where the patient was staying been disinfected, and if so, how exactly?

They were probably given help with this by the CDC or local PHD workers.

Q: What experimental therapies are available now for the patient, should he want to use them? Would you recommend anything specific?

That will depend on the patient's course of disease.

Q: Does the patient or his family members have an idea about how he got infected?

Can't answer this one and I do hope he didn't come here for care knowing he'd been exposed. But you can't rule that out.

Q: Virologist Heinz Feldmann has described procedures at the airport in Monrovia as a "disaster" and said it was the most dangerous situation he encountered during his visit to Liberia. Could the patient have become infected at the airport? Is that possibility being investigated?

Very doubtful. I saw them using skin contact to check temperatures. I don't think that was very risky for transmission. And the incubation period for this guy also suggests it was prior to the flight.

Interestingly, reporters returning from Liberia said they were checked leaving but not arriving. Some international airports are dropping the ball.

Q: What is the estimated number of people entering the United States each week who have recently been in one of the countries affected by the epidemic?

I can't believe that reporter didn't look this up. I don't know. But the flights from the affected countries at least should be easily checked.

Q: The number of Ebola cases is roughly doubling every 3 weeks; CDC's own worst case-scenario says there may be as many as 1.4 million patients by 20 January. Should the United States and other countries prepare to see imported cases on a regular basis?

Yes, they should already be prepared. But, they need to be just as prepared for potential cases as for actual cases. The bottleneck will be if we run out of beds in hospitals with proper isolation and ventilators.

Q: The World Health Organization has raised the possibility that Ebola could become endemic in West Africa. If that happens, how should the United States deal with people traveling from these countries in the future?

It already is endemic in the animal reservoir. It's not going away anytime soon.

Q: One more question, Dr. Frieden. The United States is paying a lot of attention to this single case right now. Do you think that will increase the amount of money and number of people the United States is willing to dedicate to containing the outbreak in West Africa?

Ebola is scary. It'll get more funding than say, gun and traffic deaths, which people are attenuated to.

 

[Skeptic Ginger]

The throw nurses under the bus crowd are keeping it up. None of the hospital spokespersons are stating the obvious, "the ED doctor (or nurse practitioner or PA) missed it". They keep saying "staff failed to pass it on to the team."

Pisses me off to hear this kind of protecting of certain staff at the expense of others. The triage nurse did her (or his) job and asked a screening question that no doubt the hospital infection control or quality assurance staff had them add to the history questions they ask every patient with illness symptoms. If they asked the question, chances are the answer was written down on a form (or typed into the computer).

The medical provider didn't look and even if it wasn't documented, should have asked the question as part of their routine history and physical. Shame on the hospital spokespersons for covering that up.

I wish the news media would ask the obvious, why didn't the doctor ask?

 

[jimbob]

It looks a bit of a cockup all round:

http://www.nytimes.com/2014/10/03/us/dallas-ebola-case-thomas-duncan-contacts.html

Initially, federal authorities announced at a news conference on Tuesday that Mr. Duncan first sought treatment at the hospital last Friday, Sept. 26, but that account has since been changed. The hospital issued a statement saying that the patient went there after 10 p.m. Sept. 25, when he was examined and sent home. Neither the hospital nor the federal Centers for Disease Control and Prevention explained how officials had gotten the date wrong and what effect it may have had on the investigation.

The woman who was hosting Mr. Duncan in Dallas told CNN on Thursday that she had brought him to the hospital the first time and twice told hospital workers he had been in Liberia. Still they sent him back with only some antibiotics to the apartment, where the woman was staying with one of her children and two nephews.

Over the next two days, Mr. Duncan began sweating profusely and had diarrhea. The sweaty sheets were still on her bed, she said. She put the towels he used in a bag but did not know what to do with them.

The woman, whom CNN did not identify by name, said she had no symptoms at this point.

On Thursday, Mr. Duncan’s nephew said that even after his uncle was rushed to the hospital three days after his initial visit, vomiting and gravely ill, he did not feel they were acting with enough urgency and called federal authorities himself to alert them to the situation.

“I called C.D.C. to get some actions taken because I was concerned for his life and he was not getting the appropriate care,” the nephew, Josephus Weeks, told the NBC program “Today.” “And I feared that other people might get infected if he was not taken care of.”

 

[Toke]

Have anyone mentioned boat refugees from africa arriving in italy and spain?
What happens when they start showing up sick?

 

[jimbob]

Have anyone mentioned boat refugees from africa arriving in italy and spain?
What happens when they start showing up sick?

I imagine it takes some time to travel such a route from West Africa given that borders must add some delay.

 

[Toke]

I imagine it takes some time to travel such a route from West Africa given that borders must add some delay.

An infected does not have to make it all the way. Refugees are likely assembled on the way in less than sanitary conditions.

 

[catsmate]

Have anyone mentioned boat refugees from africa arriving in italy and spain?
What happens when they start showing up sick?

In all probability, given the length of the journey and the conditions prevalent, it'd probably spread rapidly around the boat and be pretty obvious.

I suspect after the first such vessel is discovered the hoof-and-mouth disease solution will be applied to refugee boats.

 

[pakeha]

Have anyone mentioned boat refugees from africa arriving in italy and spain?
What happens when they start showing up sick?

This.
Given that most of the refugees are sub-Saharans, it's simply a matter of time before this situation arises, correct me if I'm wrong.

 

[BenBurch]

This.
Given that most of the refugees are sub-Saharans, it's simply a matter of time before this situation arises, correct me if I'm wrong.

I don't think you are wrong.

I also worry about smugglers. They tend to skip official border crossings for some reason...

 

[a_unique_person]

The IMF is now saying there is a need for "real action".

 

[catsmate]

Ashoka Mukpo, a freelance journalist working for NBC, has tested positive for Ebola. According to NBC News he 'felt compelled to return to Liberia to help shed light on how the crisis was being handled socially and politically'. He's being flown to the US for treatment.
More.

A Ugandan doctor suffering from Ebola has arrived in Frankfurt from Sierra Leone for treatment.

 

[catsmate]

From the current issue of The Lancet.

Ebola: a call for blood transfusion strategy in sub-Saharan Africa

WHO has stated that convalescent blood or plasma is an option in the treatment of Ebola. In 1999, transfusion of locally collected convalescent blood helped decrease Ebola mortality. WHO recommends collection of convalescent plasma to treat patients in the fight against the Ebola outbreak.1 As there is an estimated 70% mortality, a randomised clinical evaluation involving 50 patients, receiving convalescent and control normal plasma, would be sufficient to confirm the usefulness of this approach in treatment strategies.

Case fatality rate for Ebola virus disease in west Africa

The case fatality rate (CFR) for the 2014 Ebola outbreak in west Africa has been widely reported to be much lower than for most previous outbreaks. However, this low rate is not necessarily a feature of the infection itself. Rather, it is likely to be the result of a failure to account for delays between disease onset and final outcome. The low reported CFR values were generated from a so-called naive CFR calculation, in which the total number of deaths reported so far is divided by the total number of cases. Based on WHO reports up to Sept 7, 2014, which include 2226 deaths and 4390 cases, the naive CFR estimate is 51% (95% CI 49—53%).

Ebola: an open letter to European governments

After months of inaction and neglect from the international community, the Ebola epidemic in west Africa has now spiralled utterly out of control. Today, the virus is a threat not only to the countries where the outbreak has overwhelmed the capacity of national health systems, but also to the entire world. We urge our governments to mobilise all possible resources to assist west Africa in controlling this horrific epidemic. Based on our expertise in public health and emergency response, we believe the following measures would be particularly effective.

First, with regards to human resources, given the huge need for trained health-care professionals in west Africa, we urge European governments to create mechanisms that allow professionals working in public health-care systems to volunteer for temporary leave (with hazard pay) to contribute to the epidemic control efforts in the region. European countries can and should step up to contribute in line with their capacity and potential.

Second, regarding technical and infrastructure support, there is a huge need for field laboratories, epidemiological and microbiological surveillance resources, diagnostic equipment, and mobile communications software and technology. These needs go hand in hand with basic infrastructure requirements such as electric generators, clean water, and fuel. European countries have the resources and the knowledge to deploy them.

Third, with respect to medical supplies, health-care professionals and communities are in desperate need of personal protective equipment as well as disinfectants, such as soap and chlorine. While health-care centres should have priority, they are completely overwhelmed, and many infected people are receiving care at home. European countries should actively seek to procure and distribute protective clothing to all health-care professionals on the ground as well as to communities in need.

Finally, with regards to transport and logistics, governments should go beyond requesting private companies to resume travel to the affected regions (a measure that is not only epidemiologically unnecessary, but also counterproductive) and create strong incentives for them to do so, while also mobilising military and civil transport by air, sea, and land to ship food, supplies, and personnel to the affected regions.

If we aim for our action to be truly effective, Europe's strategic approach to responding is just as important as its financial and material commitments. We call on our governments to take an active and dedicated role, in partnership with west African countries and the UN, to ensure that the response over the next months is managed transparently and effectively, and in ways that support complementary goals for human and economic development in the region.

First, aid should be channelled to organisations already on the ground, particularly those led or primarily staffed by west Africans. This includes national, public health systems as well as non-governmental organisations. Médecins Sans Frontières has been playing an important part, but groups run by west Africans are in the best position to engage local support, act as cultural mediators between international actors and local populations, and build capacity among community stakeholders.

Second, the response should catalyse the link between health and development. The Ebola epidemic has eco-social origins and societal costs that go far beyond the health effects, so all possible efforts should be made to ensure that international donations support—never replace—local economies and social systems.

Third, built-in mechanisms for governance, monitoring, and evaluation should be established. European governments have an obligation, both to their own constituencies and to the communities in need, to deter (and punish) waste and graft so that scant resources are used as effectively as possible. In light of the €97·5 million that the European Commission has announced in budget support measures to Sierra Leone and Liberia, the immediate relevance of solid accountability measures is clear.

Finally, affected populations should benefit from their contributions to research. Those in the affected countries will contribute to the discovery of effective drugs and vaccines and to models of care as researchers, field workers, and, above all, participants in research.

Since Ban Ki-moon entreated the international community to help on Sept 5, 2014, several countries have stepped forward with donations, equipment, and personnel. This global response is long overdue, but we fully expect all our European democracies (predicated on principles of solidarity, equity, and social protections) to make up for lost time with celerity, determination, and commitment. The Ebola epidemic represents a public health imperative; unchecked, it might very well become a geopolitical crisis.

Containment in Sierra Leone: the inability of a state to confront Ebola?

The present Ebola virus disease outbreak is spreading across west African nations with alarming rapidity. As of Sept 21, the total number of recorded cases has soared to 6263, with 2917 deaths. The situation is very likely to continue to worsen when the affected countries witness the exhaustion of their capacities to respond to a threat of this magnitude, and because massive international assistance is still sorely lacking on the ground.

The Institut Pasteur network: a crucial partner against Ebola

After months of confusion and a slow response, the international community has finally been galvanised to respond to the outbreak of Ebola in west Africa, which could become one of the worst infectious-disease-driven humanitarian crises of recent times. With five countries affected (Guinea, Sierra Leone, Liberia, Nigeria, and Senegal), more than 6500 cases of probable, confirmed, and suspected Ebola reported, and over 3000 deaths, this Ebola outbreak is the largest ever seen. Latest projections are alarming—the US Centers for Disease Control and Prevention (CDC) has estimated that Liberia and Sierra Leone could see up to 1·4 million cases of Ebola infection by January, 2015.

Although Médecins sans Frontières (MSF) made early calls for strong, coordinated international action to address this public health crisis, WHO and donors have been criticised for being slow to coordinate a response and mobilise adequate capacity to control this outbreak. The truth about how the international community has responded will need to be assessed independently at a later date to ensure that lessons are learned. Meanwhile, the complexity of dealing with this Ebola outbreak has highlighted the need for traditional actors, such as WHO and the CDC, to embrace the wider health and humanitarian community. Indeed, this outbreak has shown how important scientific networks, such as the Institut Pasteur, can be for adding urgent capacity when a surge response is needed. It is important to understand how these networks operate, their comparative advantages, and their added value in times of crisis.

Priorities for Ebola virus disease response in west Africa

In their Viewpoint, Annette Rid and Ezekiel Emanuel urge to “focus on strengthening of health systems and basic infrastructure, rather than experimental treatments and vaccines”. Although we agree that dysfunctional health systems have contributed to the continuing amplification of Ebola virus disease in west Africa, we disagree that resources to address these gaps should be prioritised in the midst of an outbreak. Instead, efforts to improve patient outcomes should be the highest priority, and should target both optimisation of supportive care of patients and assessment of the added benefit of promising investigational therapeutics.

As clinicians working in Ebola virus disease outbreaks in Guinea, Sierra Leone, and the Democratic Republic of Congo, we saw how the absence of health personnel to provide supportive treatment resulted in suboptimum clinical care and the devastating loss of human lives. If the tools, expertise, and human power to improve supportive clinical care were made available by governmental and non-governmental relief agencies, however, these poor outcomes would undoubtedly change.

 

[dudalb]

Ebola strikes,
people in fright,
Deep in the Heart of Texas...

 

[pakeha]

^
http://www.bbc.com/news/world-us-canada-29481069

Thomas Duncan, who caught the virus in his native Liberia, is now in a serious condition in hospital. This is the only Ebola case recorded so far in the US.

The flat in Dallas where he lived before being isolated is being cleaned by hazardous materials specialists.

The four people living there have been moved to a private home offered by a volunteer.

Louise Troh, thought to be Mr Duncan's girlfriend, her 13-year-old son and two nephews have spent days inside the flat under the orders of health officials.

The family was driven away from the home in a police car, after officials failed to find shelter for them.

Hotels, flats and others had refused to offer them accommodation, before a private residence was offered.

"No one wants this family,'' said Sana Syed, a Dallas city spokeswoman

I don't think you are wrong.

I also worry about smugglers. They tend to skip official border crossings for some reason...