Ebola - all or nothing?

[DrDemento]

Re: Ebola - all or nothing?

So far, cases that have been treated here are crushing the typical mortality rate. The only one lost to my knowledge is the Liberian national and who knows how far along he was before he got here or therapies began.

Perhaps my terminology was a bit vague. Other than basic support measures, what treatment is there for this virus? We are able to provide very good supportive care-fluids, nutrition, ventilation, dialysis, etc. But i have not seen any effective treatment that we can offer for this disease as yet. If this continues, and all we can offer is supportive care, it seems very unlikely that we will have enough facilities or personnel to be able to treat more than a very few patients at a time.

 

[DrDemento]

Re: Ebola - all or nothing?

Bad news and good news reply:
we only how contagious it is right now, it is demonstrably mutating as it moves from person from person and even as it spreads within one person's body (see New Yorker article cited earlier). So far those mutations do not seem to have affected its method of transmission. The scary potential mutation would be one that is less lethal, people might then catch it and remain debilitated for a longer period of time. Right now, either you die or you recover pretty quickly. A virus transmitted through a person's bodily fluids, if that includes perspiration, if it mutates to be less deadly, then no one will ever want to touch a doorknob or a railing or any other place people touch with bare hands. Let's pray this never happens!

Good news, one treatment that seems "moderately effective" is to use blood serum from people who have recovered. Apparently these people now have anti-bodies that attack the protein shell that encapsulates the RNA.

It is starting to look exactly as you said, DrD: our biggest problem now is complacency.

you only left out one of my more major concern-the development of some sort of carrier state. Where there are no symptoms at all, but the virus is still present in some form in some tissues and could eventually be activated to a transmissible state. We have yet to discern if Ebola presents as a gradation of disease. Thankfully we have not seen the ease of transmission rise(and hopefully this will not happen).

 

[FreshFish]

Re: Ebola - all or nothing?

Other than basic support measures, what treatment is there for this virus?

There is an experimental drug called ZMAPP that appears to be quite effective.

Very few doses are available at this time, but they are ramping up production. Apparently they splice a gene into a plant and then grow the plant and then extract the drug, though I am writing from memory and might have a detail wrong.

 

[DrDemento]

Re: Ebola - all or nothing?

There is an experimental drug called ZMAPP that appears to be quite effective.

Very few doses are available at this time, but they are ramping up production. Apparently they splice a gene into a plant and then grow the plant and then extract the drug, though I am writing from memory and might have a detail wrong.

Fish: Way too early to know how effective this or any other specific treatment has been. Too many people making comments in public right now. Most of them with zero medical training. Most with limited medical knowledge. Most just reading what they have been handed. The media introduce some speaker as Doctor-but as most of us know, that can be a pretty generic term. There are a limited number of experts with this disease and some of them have only laboratory experience and no patient treatment or diagnosis experience. By no means am I being negative here. I am being extremely cautious about a process that lots of people are spouting about by quoting statistics and names and numbers from Google and Wikipedia. This story is just starting. I hope it is a like an O Henry short story with a quick happy ending. What we are seeing now though is a bit of media frenzy and some political posturing and i do not appreciate any of it.

 

[Gurtholfin]

Re: Ebola - all or nothing?

Perhaps my terminology was a bit vague. Other than basic support measures, what treatment is there for this virus? We are able to provide very good supportive care-fluids, nutrition, ventilation, dialysis, etc. But i have not seen any effective treatment that we can offer for this disease as yet. If this continues, and all we can offer is supportive care, it seems very unlikely that we will have enough facilities or personnel to be able to treat more than a very few patients at a time.

Maybe you are saying this, but we have the facilities to treat a lot of these patients. What we may not have is enough trained personnel to do it safely or enough of the high tech facilities where transmission is nearly impossible.

I would guess that every decent sized hospital has the supportive care equipment.

 

[FreshFish]

Re: Ebola - all or nothing?

What we may not have is enough trained personnel to do it safely.

I did not see it myself, someone described it to me.

Apparently there is video of two police officers who were on patrol outside the infected Dr.'s apartment in NYC. They were wearing facemasks and protective gloves. At the end of their shift, they peeled off the face masks and gloves and tossed them into a trash can sitting on the sidewalk, then walked away.

 

[DrDemento]

Re: Ebola - all or nothing?

Maybe you are saying this, but we have the facilities to treat a lot of these patients. What we may not have is enough trained personnel to do it safely or enough of the high tech facilities where transmission is nearly impossible.

I would guess that every decent sized hospital has the supportive care equipment.

You would be guessing incredibly wrong. We have some wonderful large teaching hospitals and some well staffed large hospitals-some of which might be able to handle a few of these types of cases. Most of the hospitals in this country and virtually all of the staffs cannot remotely handle anu significant cases and I am sorry to say, a great number could even handle one single patient needing this kind of care. Even the 5 major hospitals that are specially equipped for this can each only handle a handful of patients each.

 

[FreshFish]

Re: Ebola - all or nothing?

I would guess that every decent sized hospital has the supportive care equipment.

By silent implication, I'd say the Feds now do not totally agree with you since they have said they want to channel all people with passports from Guinea, Sierra Leone, and Liberia only to five arrival cities.

 

[FreshFish]

Re: Ebola - all or nothing?

I heard an interesting comment from someone a few minutes ago. She heard something on the TV news about "Ebola panic" and snorted, "baa, it isn't an 'ebola panic'. People aren't worried about catching Ebola. People aren't sure if the government has a handle on the situation. That's what we're worried about!"


Got me thinking, from the specific to the general...

In general, this is always a very reasonable consideration, is it not?: "something is wrong, can the people in charge handle it?" we've all lived through it at work, at home, with sports teams: they/we run into a challenge that throws the group into disarray, how will they/we respond to the situation?

An example of competent leadership in this kind of situation, in general, is to acknowledge that consideration openly: anyone with minimal knowledge and experience in this area knows that the more you try to dismiss this kind of consideration, the deeper you ingrain it. That's how people work, that's human nature, that's probably how you respond when someone tries it on you. If someone says to you "don't worry" and you're not quite sure whether you can trust them or not, does that help you?

Rather than dismiss the consideration, the time-tested method is to address it head on in nonpejorative descriptive terms: "we've never faced a situation like this before, and we can certainly understand how people might have an air of uncertainty about what to do. Here's what we expect to happen, here's what we plan to do about it, and here's what you need to do for the whole enterprise to come to a successful conclusion."

It's generic and well-established basics in certain professional circles.




The one thing you never want to do, ever, in this situation, is to try to "reassure" people. People become reassured as a byproduct of effective leadership.
i.e., A good leader never tries to reassure people, instead s/he tries to instill in people a sense of reassurance.



I'm hoping that by having the right professionals in the right place, we can focus attention where and as needed to have effective outcomes.

I am glad to see that the CDC seems to learning and improving. When the discussion started on this thread, I said I had far more confidence in the NY City Dept of Health than I did the CDC. Since then, the gap has narrowed.

 

[joecct]

Re: Ebola - all or nothing?

three tweets from Gov. Christie

Governor Christie ‏@GovChristie 18m18 minutes ago
From @NJDeptofhealth: "The healthcare worker Governor Chris Christie indicated earlier today would be quarantined...(cont)

Governor Christie ‏@GovChristie 17m17 minutes ago
"...because of a recent history of treating Ebola patients in West Africa had no symptoms upon arrival at Newark Airport earlier today."

Governor Christie ‏@GovChristie 18m18 minutes ago
"This evening, that health care worker developed a fever & is in isolation &being evaluated at University Hospital Newark." @NJDeptofhealth

I think there's a real big hint there Governor and Health Department folks.

 

[FreshFish]

Re: Ebola - all or nothing?

I think there's a real big hint there Governor and Health Department folks.

Will be interesting to see how the feds respond to this:

The governors of New York and New Jersey on Friday imposed mandatory 21-day quarantines for at-risk travelers arriving at JFK and Newark Liberty airports from Ebola afflicted countries – tough new measures that far exceed those imposed by the feds.

They said that the “voluntary screening” policy of the Centers for Disease Control and Prevention was ineffective, and that they acted because the CDC’s shifting guidelines weren’t sufficient to protect the public from the spreading contagion.

“A voluntary Ebola quarantine is not enough. This is too serious a public health situation. I think increasing the screening procedures is necessary and reduces the risk to New Yorkers and people in New Jersey,” Cuomo said.

Both governors. NY and NJ.

 

[FreshFish]

Re: Ebola - all or nothing?

My own opinion is that the governors "should" have included in their announcement that this quarantine is merely a temporary measure until a safe and reliable test for Ebola is developed, after which people can enter the country far sooner than 21 days if they prove Ebola-free upon testing.

The other thing they didn't mention (or if they did, I missed it) is what would happen if a person were found to have Ebola before the 21-day period elapsed? one assumes that person would be treated, I can't imagine them shipping him/her anywhere nor can I imagine them just leaving him/her to die.

They have to beware of unintended consequences, though. What if a bunch of people with nowhere better to go start flying here just to take advantage of the free 21-day housing, all meals included? What if they develop Ebola symptoms here? Who pays for the treatment? If they finish the quarantine symptom free and have nowhere to go afterward, then what?

I can easily imagine a black market human smuggling ring developing under their approach if they try to maintain it for very long. If there's a way to exploit human misery for money, there's bound to be a criminal gang sniffing around sooner or later.

 

[Gurtholfin]

Re: Ebola - all or nothing?

You would be guessing incredibly wrong. We have some wonderful large teaching hospitals and some well staffed large hospitals-some of which might be able to handle a few of these types of cases. Most of the hospitals in this country and virtually all of the staffs cannot remotely handle anu significant cases and I am sorry to say, a great number could even handle one single patient needing this kind of care. Even the 5 major hospitals that are specially equipped for this can each only handle a handful of patients each.

So how is it that Africa's hospitals are overflowing? They are clearly taking on more than one patient at a time.

I was referring to the actual equipment - not the expertise or protocols already in place. Are you saying that most of our hospitals don't have dialysis machines and the capability to keep patients hydrated?

I think what you are referring to is the number of facilities in our country that are experts in this field and that could do it with as little risk as possible to the staff or caregivers. I have read and heard those reports also.

Yes - the ability to treat patients under these ideal circumstances is limited, but if this shat the fan, the ideal circumstances would be out the window.



Here is a listing of dialysis centers that are listed with this site (undoubtedly there are more as these directory sites are never all-inclusive):

http://www.healthgrades.com/clinic-directory/dialysis-centers


Here is a listing of the therapies that patients may need:

http://www.cdc.gov/vhf/ebola/treatment/


There are lots of hospitals in the US that can do all of these things and would if a pandemic broke out here. They'd be forced to just like the ones in Africa have been.

The difference is that our hospitals would do it better.

 

[Gurtholfin]

Re: Ebola - all or nothing?

By silent implication, I'd say the Feds now do not totally agree with you since they have said they want to channel all people with passports from Guinea, Sierra Leone, and Liberia only to five arrival cities.

Gee, you think that might be so that they don't need a trained crew and protocols in every airport in the country?

It's for efficiency.

 

[FreshFish]

Re: Ebola - all or nothing?

Gee, you think that might be so that they don't need a trained crew and protocols in every airport in the country?.

Sounds like we are pretty much saying similar things in different words with different emphasis.

 

[FreshFish]

Re: Ebola - all or nothing?

CT governor joins NY and NJ in mandatory 21-day quarantine.

That's two D govs and one R gov if anyone actually thinks party labels matter in this situation.

 

[DrDemento]

Re: Ebola - all or nothing?

So how is it that Africa's hospitals are overflowing? They are clearly taking on more than one patient at a time.

I was referring to the actual equipment - not the expertise or protocols already in place. Are you saying that most of our hospitals don't have dialysis machines and the capability to keep patients hydrated?

I think what you are referring to is the number of facilities in our country that are experts in this field and that could do it with as little risk as possible to the staff or caregivers. I have read and heard those reports also.

Yes - the ability to treat patients under these ideal circumstances is limited, but if this shat the fan, the ideal circumstances would be out the window.



Here is a listing of dialysis centers that are listed with this site (undoubtedly there are more as these directory sites are never all-inclusive):

http://www.healthgrades.com/clinic-directory/dialysis-centers


Here is a listing of the therapies that patients may need:

http://www.cdc.gov/vhf/ebola/treatment/


There are lots of hospitals in the US that can do all of these things and would if a pandemic broke out here. They'd be forced to just like the ones in Africa have been.

The difference is that our hospitals would do it better.

You do like to argue, don't you. I do not need a list of dialysis centers to know that almost every bed in them is filled right now and there are even waiting lists for some of them-all this without having to treat Ebola. We are talking about full time isolation for each Ebola case and yet providing full time supportive care. Do you have any idea of what extensive supportive care is? Do you have a clue how many personnel have to be dedicated virtually to each patient? I have read lots of your posts on other threads and you are a very bright articulate person. But saying we have have even remotely the capabilities in this country to treat a full fledged Ebola epidemic is just madness. Most of the medical people we have in this country have zero training in containment and treatment of infectious diseases like this. The average doctor cannot do it, the average nurse cannot do it, and most certainly the small community hospitals that are OK for a hernia repair are as well equipped for this disease as your local Holiday Inn. I attend at 5 local hospitals here in NJ(and on the infection control committee of one) and if we had a single case of Ebola diagnosed, he or she would have to be rapidly evacuated to a major center(and there are none in NJ at all to serve 8 million or more people) that is properly equipped and has the proper trained personnel. With over 300 million at risk of a disease, 5 hospitals each equipped to handle about 5-10 stricken patients is just not a number I am comfortable with.
As far as having the equipment-try again. Most local hospitals do not have and could not afford any where near what would be necessary. Right now we have a handful of cases or suspected cases. If we had the same number of Ebola cases as we see cases of influenza, the health system in this country would be overwhelmed beyond any imagination. This disease is not whopping cough. It presents special problems and needs that very few diseases do.
And remember, while all this is going on, our hospitals are pretty full and medicare care is pretty extended with heart attacks, cancer patients, other infectious diseases, etc, etc. Do we just stop everything and treat Ebola instead?

If this thing really gets going (and honestly, I do NOT see that happening), our medicare care system would be almost as useless as what is provided in the African countries now involved. Our saving grace thus far is that 1)it does not appear to be very contagious 2)we have not had an onslaught of people coming across the borders with it 3)we have done a few things to limit it's appearance here and 4)terrible to say, but it the fact that it is over 50% lethal rapidly usually means a lot of people will die from it before they have the chance to spread it around more than they do. This may not be a Nostrodamian type of prediction for the end of civilization, but something not much different than this type of virus could be. Add a few factors to this kind of virulency-airborne contagion(like pneumatic plague), animal vectors in close living quarters to us(dogs, cats, birds, rats), and insect vector(mosquitoes, houseflies)-and you could have the solution the world over population problem all wrapped up into one neat little package.
There have been plagues in past history with most of these factors, but history has shown us that the lack of rapid patient mobility(no 757's to fly), natural barriers like oceans, and in general isolation of some land masses(islands unreachable easily) has limited the extent of involvement. Most doctors suffer from a major failing-they never like to say that they truly do not know. They offer opinion when asked but the underlying scientific facts are just not there. We are getting a lot of this right now. The media has every so called expert on TV almost every hour. But, in my opinion(and it is only an opinion) we just do not have enough knowledge backed up by scientific facts, to really answer all the questions raised about this thing. I am quite confident that this overhyped panic will end-this is not the big one. But the media is playing it like it is. But the next one may be. One day a 9.0 will hit California. And one day, some entity will arise that has all the qualities I mentioned above and we will have no defense for it. I just hope it is not on the horizon.

 

[FreshFish]

Re: Ebola - all or nothing?

But saying we have have even remotely the capabilities in this country to treat a full fledged Ebola epidemic is just madness. Most of the medical people we have in this country have zero training in containment and treatment of infectious diseases like this. The average doctor cannot do it, the average nurse cannot do it, and most certainly the small community hospitals that are OK for a hernia repair are [not] well equipped for this disease.

and that assumes that all the staff will continue to show up for work every day as if nothing different were going on. There was a story that after the NY MD was taken to Bellevue, there was a spike in staff people calling in sick.

 

[Gurtholfin]

Re: Ebola - all or nothing?

You do like to argue, don't you.

I'm not arguing for argument's sake. I acknowledge your expertise and points. I don't believe you are understanding what I'm trying to say though - which may be my fault for not articulating better.

I'm not saying that any of those hospitals are actually prepared for an ebola case - only that if pressed into service, they could, and would administer whatever therapies possible.

I do understand supportive care and my own son has been in isolation - granted for something far less deadly and at a much lower level, but I've seen what the staff had to do for his particular case.

While in the PICU, there were heart & lung transplant patients and they were at a far higher level of both supportive care and isolation. Still obviously not ebola level, but I've seen that too.

My only point is if the **** hits the fan, I don't see us as a society simply giving up and saying that we just can't treat these people. I believe that our hospitals will do the best they can and that medical staff will learn on the fly - those that still show up for work anyway.

I clearly stated that I understand that the expertise and protocols don't exist in these hospitals - just the equipment and medical personnel who at least can don a hazmat suit, administer an iv, take a blood test and give medicines.

I know it would be a disaster and that we're not prepared for it, but to say that there are only 5 hospitals (or whatever) in this country who could do anything for these patients in and of itself is false. That's not how it would play out if this blew up.

To say that as a nation, we can only treat 4 or 5 ebola patients at a time is false. We can only treat that many under the best possible circumstances, but we could, and would, treat every single one that presented itself - even if that meant the military setting up mobile facilities like what is being done in Africa.

That hospital in Texas tried to treat. They failed, but they tried and as an epidemic wore on, more hospitals would be forced to try and we'd get better at it. We'd have to.


Do you honestly believe that we'd just give up or turn these people away? If we had cases here, it would still be a relatively small percentage of our overall population as thankfully the communicability of this disease is fairly limited compared to say the Spanish flu would have been.

Bird flu and other airborne/deadly pathogens are what scare the **** out of me. That's where we'd see a breakdown in society, imo.

 

[joecct]

Re: Ebola - all or nothing?

Call me concerned. Proper prophylaxis should keep me and my loved ones safe. But I am still concerned that our government is not taking the best preventive methods.

http://www.infowars.com/u-s-army-ebola-goes-airborne-once-temperature-drops/