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© Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.Dallas health worker tests positive for Ebola
By NOMAAN MERCHANT DALLAS©2024 GPlusMedia Inc.
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CrazyJoe
"The virus is moving on virus time; we're moving on bureaucracy or program time" ( Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy).
globalwatcher
This is a top story of Sunday morning news in US.
This story makes us very uncomfortable as Ebola is winning and we are losing. I believe this should be a White House Job #1 and we need to do everything to contain Ebola from spreading further. We cannot monkey around with this deadly beast, period.
turbotsat
Assuming that the feds are ASSUMING a "breach of protocol", or they'd provide the exact circumstances of the breach. When was the last time the protocol was updated? Was the protocol prior to that date not perfect?
There is a new case in Boston, of a recent traveler from Liberia, now under evaluation for Ebola-like symptoms. Staff in Braintree, MA had to chase after him after he left the pharmacy having reported his symptoms and his recent travel.
http://www.reuters.com/article/2014/10/12/us-health-ebola-massachusetts-idUSKCN0I10UZ20141012
globalwatcher
Does Japan have a strategic plan fighting against Ebola? This is real and hope you do.
MarkG
.....And the US sent US troops to the hotbed....
globalwatcher
Now tonight evening new is saying there are more possible Ebola patients beside this nurse. sigh........
MarkG
Spain had a problem isolating from the virus also. Seems to be a very tenacious little bug. Take every precaution and then some is a safe bet.
Seems to me the US military is not prepared for such a virus. Good training I guess but potentially fatal slip ups. They'd serve better on the US/Mex border. Oh, the great leader say they are not needed there.
Jennifer Richardson
Yep, they are assuming a breach of protocol (i.e., a breach must have occurred or she would not have been infected, so therefore a breach occurred) but are reporting it as if the breach were certain. I find it a bit misleading.
gelendestrasse
OK, that's one hospital to avoid. Not only did they blow the diagnosis of the guy they can't even keep themselves safe....
And yeah, just assuming a breach in protocol is a bit blase. Who will the next case be?
Jennifer Richardson
@MarkG
The troops are mostly combat engineers, being sent to build infrastructure, not do direct care. And helping to control the disease over there, if successful, should limit the repercussions here. Plus the humanitarian considerations are real. I am tentatively in favor of the move, although here's hoping for stringent screening, quarantine, and reintroduction procedures when they return.
MarkG
Yes, the troops are not on the front lines but they are in the hottest region of the world now. Not to mention they are targets for some of those peace loving types in N. Africa.
Jennifer Richardson
@MarkG
Yeah, not saying it's low-risk by any means, just that I think they sent the right people for the job and that there's a reasonable impetus behind it. The reduction in risk from helping to bring the disease under control may offset the risk of them catching/spreading it, but I don't really have the knowledge to make that assessment. I've just seen a lot of stuff going around the internet mocking sending troops to "fight Ebola" like they're sending in infantry to physically combat the disease or something, like it makes no sense. I agree that many, many things our government does make no sense, but I think this is actually one of their more reasonable moves (relatively speaking).
globalwatcher
Mark G
US troops will not be involved in treating Ebola patients. They will be building hospitals, setting up medical equipment and medical team's offices.
kaimycahl
We have pResident who only care about his legacy! President Ebola
Lizz
US troops are designed as a killing machine, not a social work outfit or whatever. They are not development specialists. They are not a medical expeditionary force or the Agency for International Development Disaster Assistance Response Team. The last time a contingency of Marines were deployed to Liberia for a few days 35% contracted Malaria and had to be transported to an advanced treatment center. As long as there is a clear outline of the operation with implications for future military related missions like helping to contain Ebola as a realistic form of chem-bio training I could support it, but the number of troops involved in building several hospitals seems awfully small for the task. This has got to go beyond vague mumbling about how the US is going to “degrade and ultimately destroy.Ebola" or even whether we are 'at war' with the disease at all.
Jennifer Richardson
@Lizz
They're combat engineers being sent to build infrastructure in a dangerous region. Combat engineers are not "killing machines," that's not what they do. Yeah, they can handle themselves, but their job description is pretty much exactly what they're being sent over there to do.
Admittedly, most are probably more used to working in regions where the risk is military rather than medical, and I don't doubt catastrophic mistakes could be made, but they have plenty of experience securing and clearing the areas where they work and getting on with business, which I imagine is exactly what they will do here. The rationale for sending them (which you of course may disagree with/find insufficient) is that helping control Ebola in West Africa will reduce the threat of transmission to/within the homeland, as well as the threat of further destabilization of the region, plus the humanitarian aspect.
globalwatcher
LizzOct. 13, 2014 - 10:10AM JST
Thanks to USA Tomodachi Rescue Operation for Tohoku Earthquake disaster. Hope you still remember that.
John Galt
My take is that there are some crucial things about Ebola that the experts either don't know, are mistaken, or are not sharing with the general population. Perhaps it IS airborne or is actually contagious BEFORE symptoms are apparent, or something else which contradicts the current information.
In any case, Ebola is likely to continue to spread slipping through the cracks further as it already has.
Definitely very concerning.
JoeBigs
Thomas Eric Duncan is a clear reason why every nation should check everyone that arrives from overseas and if they arrives from Africa check them twice.
Only way to combat this is to make sure it does spread!
holyholly
Maybe I'm jumping the gun, but if quarantines are necessary for animals going cross border, it might be necessary to do the same thing for humans. Of course, there will have to be a change in legally entitled holidays. 2 weeks out of country, including 2 to 3 weeks in a quarantined area. During this transition, airlines could design their airplanes with more leg room. Once it has been eradicated, we can go on living like sardines.
Hawkeye
And so it begins. Terrible news for all the care givers and hospital staff but it seems that all the Ebola infected patients should be kept at the CDC in quarantine and not allowed to be cared for by hospitals that don't know how to deal with this highly contagious virus.
In medieval times they used to catapult the deceased victims of the black plague over the walls of towns that armies were trying to take over. Perhaps the us military could use the same strategy against ISIS. I'm not kidding.
nath
It is spreading. Time to panic?
globalwatcher
I am having hard time understanding your post here. Ebola spreads very quickly and deadly.
Do you know how Incas and Aztecs civilization disappear? The entire civilization was wiped out by Smallpox.
holyholly
@globalwatcher I'm sure JoeBigs meant to say "only way to combat this is to make sure it DOESN'T spread."
If only there were an "edit" feature on this site.
turbotsat
Tooth-to-tail ratio for USA is 1 to 3 (combat + combat support troops vs non-combat-related troops).
http://en.wikipedia.org/wiki/Tooth-to-tail_ratio
<www.foreignpolicy.com/articles/2012/09/27/no_army_for_young_men>
Laguna
NIH funding down 23% over 10 years. For fiscal 2014, CDC's budget $5.9 billion, down from the $6.5 billion allotted in 2010. Surgeon General's nomination blocked for a year due to NRA objections. Folks who oppose utilizing the military to fight Ebola have to understand that that is the only American government institution that has not been savaged.
Oh, well. At least we have an excuse to quarantine Texas.
CraigHicks
This is not a statistic of one, some fully protected doctors and nurses in Africa have also contracted Ebola and returned to their countries, it has been in the news. It was just assumed that conditions in Africa caused the protocol to fail and that wouldn't happen in advanced countries. If the protocol is so difficult that workers frequently breach it, then it is not really effective. Sand gets everywhere, why not viruses in huge quantities?
The only transmissions (Dallas, Spain) have occurred attending patients who were on the verge of death - indicating that patients who are treated with drugs in a timely manner are far less infectious (/optimism). Quite an ethical dilemma about how to care for a dying patient who could give the caregiver Ebola.
It is not difficult to foresee a potential health system breakdown in advanced countries unless vaccines are available for health workers. (Just the kind of breakdown happening in west Africa). Fortunately testing has begun on an NIH vaccine last week in Mali (even though Mali has no Ebola???). Current predictions are for it to be available in Feb/March - it could be available in mid November if there were some high level direction to shake up entrenched mindsets.
I think the US president has a real chance here to build his legacy by taking control of the situation by building up drug (therapy and vaccine) production and health worker training. We should be talking in units of million of doses produced per month - but right now we just hear about 10,000 doses (of any one drug) in stock and no vision beyond that. Likewise for health workers, we need to set a goal for N x 10,000 vaccinated health workers per month in the US alone. Exponential increase is a hard concept to understand - it means when a wave eventually does come it could be a tsunami wreaking total havoc. If we are not ahead of the curve we are in big trouble. There is less excuse for not preparing for Ebola than there is for not preparing for the tsunami which hit Fukushima.
Flights to West Africa should not be canceled because they are needed for health workers who operate independently of government. However, existing visas can be suspended and new visa put on hold - it will affect separated families but it is necessary.
The main problem I see with sending 3000 building engineers to build US built hospitals and offices is the problem of scale. I don't think it is enough to get ahead of the curve. Maybe 300,000 engineers today to build 500 hospitals would be enough to shut Ebola down, but the US simply cannot muster that right now. A far better idea is to make use of the highly motivated people of Liberia and Guinea (don't count on those governments though) by supplying them materials they can assemble themselves to build what they know how, and incrementally increase their technical knowledge through dedicated trainers.
turbotsat
Just google "CDC boondoggles" or "NIH boondoggles".
Executive and legislative branches are paid big salaries but can't even muster the leadership or capability to move money from where it's not needed to where it is needed, the Ebola fight, on an emergency basis.
WA4TKG
Some of you may recall my previous statement: I said; WHY are you taking INFECTED PEOPLE INTO the USA ?; Treat them ELSEWHERE...WHY fly them ALL THE WAY AROUND the world ? Idiots.
Laguna
The Pentagon budget for 2015, at $756.4 billion, dwarfs the CDC's such that the latter makes up 0.0078% of the former. To put this into perspective, the Pentagon spends at least $140 million every year on golf courses. If you want to find boondoggles, go to where the money is.
Silvafan
Mr. Duncan's name was given to the media immediately, but the healthcare worker's name hasn't been given. Why keep their name secret with possible chance of them spreading it to others. It seems like they are pulling a Japanese media move with the respect for certain people's privacy. (Only Japanese)
I wonder if it was because he was Black, he was a foreigner or he was both.
globalwatcher
WA4TKGOct. 13, 2014 - 02:08PM JST
Absurd. They are Americans. America is still offering the best cutting edge resources in medicine.
stormcrow
I think they'll be able to stop the spread, however, I'm also wondering about every passenger he flew with and everything he touched between Liberia and Dallas and every person and thing he came in contact with between those 2 places.
The Ebola experts say that there's no danger to anyone as long as he wasn't too sick, but how would you feel if you found out he was the guy you were sitting next to and talking with on a long international flight? How about any and all of the restrooms and toilets that he had used?
LaWren
So when are the CDC going to confirm that it has indeed gone airbourne, then?
stormcrow
LaWren,
Excellent question. There have been cases where the Ebola virus has been spread between different animal species through the air.
Viruses do mutate and evolve so it is a possiblility.
LaWren
If it cant be easily explained how either the Spanish nurse or the American one contracted it, the surely it does have to be considered that perhaps the virus has mutated, or that such a minute amount is needed to infect that a sneeze, a trace from sweat on a surface is enough to transmit.
Something that killed like ebola but spread like flu would be devastating, especially with the long 21 day incubation period. Im keeping a close eye on this, Im not worried yet, but am prepared to get worried.
Lizz
It could be the protective gear is not sufficient also, particularly in the latter stages of the illness.
turbotsat
Yes, the Pentagon has lots more boondoggles that should be eliminated, and no, the CDC's budget is not equivalent to the Pentagon's, just like an orange is not equivalent to truckload of apples.
CraigHicks
Whether Ebola is airborne or not would seems to depend upon the definition of "airborne". The documented pigs-to-monkeys transmission is one focal point of this debate:
http://healthmap.org/site/diseasedaily/article/pigs-monkeys-ebola-goes-airborne-112112
One part of the definition would be whether the Ebola virus could survive on dry dust. Another part would be the size of liquid particle on which an Ebola virus would be -likely- to be found, because minute liquid particles are truly airborne, where larger particles sink rapidly.
Ordinary flu is recognized as being airborne and has a higher rate of transmission than Ebola - from which it is arguable that Ebola is not airborne. But if we look just at cases of dying Ebola patients, the transmission rates go way up - does that conversely mean in those cases it could be airborne?
"Airborne" might not be a useful or appropriate term without further qualifications.
Fadamor
There's nothing in the source you cited (nor in any of the other news reports about the man) that indicate "staff had to chase after him". He was admitted, isolated, then transferred to the other hospital.
http://www.bostonherald.com/news_opinion/local_coverage/2014/10/boston_officials_step_up_ebola_vigilance
turbotsat
That's quite a big data set for a human to declare certitude on. (Google News shows 10,900 hits for "braintree ebola". Boston.com is owned by the Boston Globe.)
http://www.boston.com/news/local/massachusetts/2014/10/12/braintree-hospital-isolates-patient-with-ebola-like-symptoms/BJk9dYCxIbcapX6f9CIwtN/story.html
Jennifer Richardson
I am actually inclined to think that the CDC & other health organizations are being too sanguine about the efficacy of their protective protocols, and think it's entirely possible that Ebola is easier to spread than they are willing to acknowledge, but the whole "viruses mutate and Ebola could go airborne" thing, while it sounds reasonable on the surface, is quite a stretch. HIV/AIDS could also mutate, but we don't assume it's "gone airborne" every time someone turns up who doesn't know how they've contracted it. The chances of a truly bloodborne pathogen randomly mutating into an airborne one is infinitesimal.
That being said, it is widely acknowledged that Ebola is both infectious and stable in small-particle aerosolized form (we know this from experimental data; this bit is not conspiracy theory), and there is also suggestive evidence that maybe-possibly-perhaps-probably-not there could be airborne spread of some obscure subtypes of the virus.
I would not bet on airborne Ebola, but I would not be shocked if aerosols are more of a problem than the Powers That Be are letting on. Human error is still the most likely explanation for the nosocomial infections, but the rate of infection amongst highly-trained, highly-motivated-to-not-catch-Ebola medical personnel does seem to invite suspicion, and the CDC responses read as rather dismissive.
With our grand total of two cases (unless there's been more since I turned on the news?) in the US, you'd think that we could manage some slightly more foolproof decontamination measures, perhaps immediately before medical personnel divest themselves of their protective gear, which is when errors are most likely to occur. If such measures prove ineffective, we might get a little more insight into whether these transmissions are really attributable to human error, of if the virus is more infectious than is commonly acknowledged.
JoeBigs
This disease is being spread by human ignorance. Folks need to take this outbreak for the threat it really is. The Obama administration and other leaders have acted too slow because they didn't want to offend anyone. But after this disease has begun to spread they are now trying to play catch up.
The first line of defense in fighting this disease is at the border. If Mr. Duncan would have been properly screened he would never have effected anyone. I just wonder how many more Mr. Duncan's are out there?
This is what happens when folks listen to ignorant rumors and conspiracy theories.
In Liberia, locals were convinced that the Ebola epidemic wasn't harmful and some sort of government ruse, so they raided a center "FREED" the patients and stole what they could. They took anything they could get their hands on, infected or not.
http://news.nationalpost.com/2014/08/17/ebola-patients-flee-quarantine-centre-in-liberia-as-local-mob-on-looting-spree-steals-bloody-sheets-mattresses/
Then there are the silly religious frauds who are trying to make a buck off the disease.
http://www.washingtonpost.com/blogs/worldviews/wp/2014/07/31/nigerian-official-warns-pastors-and-healers-to-stop-making-false-ebola-cure-claims/
The Aztecs were killed off by their own religious ignorance. Small pox and measles were just by products of that ignorance. (since I just woke up hope I haven't made any mistakes)
And ignorance again is helping this latest outbreak to spread.
My apologize, but was writing on a tablet while riding a train, won't let that happen again. 30 lashes sound appropriate?
CraigHicks
Can you explain why your words are not in self-contradiction? Isn't aerosol airborne?
Again, I cannot help but see a contradiction here. Wouldn't a subtype be a mutation of the main type?
turbotsat
http://fox43.com/2014/10/13/ebola-five-ways-the-cdc-got-it-wrong/
LaWren
Im just an interested lay-person, but surely if it is spread by particles in coughs and sneezes, to all intents and purposes it is airbourne?
Its not like HIV which is easily preventable, no unsafe sex, no shared needles, no dodgy blood transfusions equals no chance of getting HIV.
Craig, Ild be interested to hear your thoughts on the threat level of ebola outside of West Africa.
Jennifer Richardson
@ Craighicks
It's just a matter of terminology. Both aerosol transmission and airborne transmission (confusingly) involve aerosolized virus--small droplets or particles of infectious material suspended in air.
Basically, aerosol transmission involves transmission involves bigger droplets propelled a relatively short distance (a few feet or so) through the air (this is also referred to as "droplet transmission"). In the case of Ebola, this might be blood and saliva coughed/sneezed out, or emitted during an aerosol-generating procedure such as an intubation. This mode of transmission requires proximity to the host, but not direct contact. Ebola virus has been transmitted this way between animals under laboratory conditions. However, I want to be clear that it is not naturally transmitted this way between humans, to the best of our knowledge--obviously if an Ebola patient sneezes blood into your face, that's worrisome, but generally speaking, Ebola is transmitted via direct contact with the infected person's bodily fluids (or so they say...DUN DUN DUN).
Airborne transmission, on the other hand, refers to pathogens that basically "float around" in the air in the form of much tinier droplets or particles that can remain suspended for much longer, travel on air currents, and infect people who were nowhere near the infected host (somebody in a different store at the mall, for example, or a different aisle of the grocery store or different room in the hospital). There is some weak evidence of this happening with the subtype in question (the Reston ebolavirus, which does not infect humans), but nothing conclusive.
Basically:
Big droplet, short distance, short time = aerosol Small particle, long distance, long time = airborne
Yes, absolutely. I should have been more clear. The Reston subtype (which is not pathogenic to humans) is a mutated strain of Ebola virus (EBOV)**--what used to be called Zaire ebolavirus--which is obviously very pathogenic to humans. However, the evidence for airborne spread of this subtype is far from conclusive. In addition, just because a virus can be transmitted a certain way between members of one species does not mean that carries over to other species, even if the virus is pathogenic to both species (which Reston is not).
For instance, the reason Ebola virus was transmitted via aerosol by pigs but apparently isn't between humans is almost certainly because pigs are affected differently by EBOV, with their respiratory tissues being far more affected than those of humans, their symptoms involving far more sneezing and coughing, and their physiology leading to far more production of aerosols. This is not because the pigs had a mutant strain, but simply due to differences in physiology. If Reston can indeed be airborne between monkeys, my guess would be that it's physiological, not because of a random mutation that happened to change its mode of transmission when the subtype split off.
I don't think there's been a human virus in history that's mutated in such a way as to completely change its mode of transmission, ever, so it's very unlikely that Ebola will do so if it is actually strictly bloodborne. If we start confirming aerosolized or (highly unlikely) airborne transmission, it will almost certainly be because those were potential modes of transmission from the beginning (viruses can certainly have more than one)--which is not to say that selection couldn't contribute to a shift in the balance of transmission modes, just that EBOV is unlikely to develop an entirely new one via mutation.
If you want my best guess (for what it's worth), aerosol and fomite transmission are more of a risk than is generally admitted, and genuine airborne transmission over distance and time is not.
**Note: Irritatingly, Ebola virus and the genus ebolavirus to which it belongs are two separate things.
CraigHicks
large water particle - gravitational motion (aerosol) - Ebola friendly
small water particle - Brownian motion (airborne) - Ebola friendly (?)
dry dust (e.g. dead skin) - Brownian motion (airborne) - Not Ebola friendly (?)
How does this table look? Is it correct that a small water particle exhibiting Brownian motion is Ebola friendly? Is it unknown? Calling a small water particle exhibiting Brownian motion "airborne" kind of messes things up - should we call it "extended aerosol" instead?
I agree with your guess that "aerosol and fomite transmission are more of a risk than is generally admitted, and genuine airborne transmission over distance and time is not". And for Ebola to be able to live long outside of a hosts saline solution would require a different overall physical structure, unless perhaps Ebola's present capabilities are not raelly completely understood.
LaWren
So if it is truely airbourne it has to be transmitted through dry dust particles. In which case the world is royally stuffed. If it is tranmissible by "extended aerosol" - coughs, sneezes, sweat...we are just somewhat in trouble?
What kills it then? Would chlorine dioxide do the job?
CraigHicks
"Ebolavirus is susceptible to 3% acetic acid, 1% glutaraldehyde, alcohol-based products, and dilutions (1:10-1:100 for ≥10 minutes) of 5.25% household bleach (sodium hypochlorite), and calcium hypochlorite (bleach powder) Footnote 48 Footnote 49 Footnote 50 Footnote 62 Footnote 63. The WHO recommendations for cleaning up spills of blood or body fluids suggest flooding the area with a 1:10 dilutions of 5.25% household bleach for 10 minutes for surfaces that can tolerate stronger bleach solutions (e.g., cement, metal) Footnote 62. For surfaces that may corrode or discolour, they recommend careful cleaning to remove visible stains followed by contact with a 1:100 dilution of 5.25% household bleach for more than 10 minutes."
Also recommend reading the informative sections "PHYSICAL INACTIVATION" and "SURVIVAL OUTSIDE HOST" at URL:
http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php
"When dried in tissue culture media onto glass and stored at 4 °C, Zaire ebolavirus survived for over 50 days"
John Galt
Laguna, regurgitate Dumocrats talking points again?
"neither CDC nor NIH has been starving for cash. Not only did CDC's overall budget increase in fiscal 2014 (by about 5 percent), but so did such individual items as immunization and respiratory diseases (up $66 million for 2014), public health preparedness and response (up $103 million or 8 percent), and emerging infectious diseases (up $49 million or 14 percent). NIH, even without taking into account its short-term boost in funding from the 2009 economic stimulus package, currently has an inflation-adjusted budget of around $30 billion, roughly 50 percent higher than what it had in 1994. It gets more money today (again, accounting for inflation) than at any time during the Clinton era.
Likewise, the State Department's Global Health Program — an agency intended for situations precisely like the one in West Africa now — received a $300 million boost for fiscal 2014."
nandakandamanda
Amber Vinson, the second and most recently reported infected healthcare worker, got on a plane in Texas after reporting a temperature of 99.5 degrees.
How could she be so stupid, and how could the authorities have allowed that?
If we continue like this, humanity will surely get what it deserves.
turbotsat
OK, now they're trying to contact over 750 passengers who used the same planes Vinson did.
AND doing a refit of one plane's interior. AND 21 days paid leave for flight crew.
AND redefining the CDC protocol for post-care travel by careworkers.
Taking it a bit more serious now. Before Duncan came over didn't the medical eggheads say USA would never have such problems? All hospitals qualified to handle such?
http://www.foxnews.com/health/2014/10/17/ebola-outbreak-cdc-frontier-airlines-hunt-passengers-who-flew-with-amber-vinson/
JTDanMan
Once again, we see the terrible Republican display of partisanship over patriotism. The skriech and gnash their teeth: TRAVEL BAN!!!!!!
A travel ban wouldn't work since patients trying to get to the U.S. would simply fly to Paris, London, Frankfurt, or some other big city in Europe and then buy a ticket on a different airline to the U.S., (known as "broken travel") making it impossible to track them and inspect them at entry.
But that is too difficult for most conservatives to understand.
So the Republicans begin demanding it, making it a campaign issue, and Republican-oriented media push the idea that the President is asleep at the switch for all it is worth, even though a President Romney would undoubtedly have listened to the same experts and drawn the same conclusion. E
For them, everything is about politics, all the time, even if doing so might kill more Americans.
No honor. No shame.
nandakandamanda
And another health worker who handled Duncan's samples gets onto a friggin cruise ship!?!?!
http://www.dailymail.co.uk/news/article-2798259/ebola-scare-high-seas-cruise-ship-carrying-health-worker-handled-samples-patient-died-deadly-virus-returning-texas.html
This quote, however, has to be good news: "Ebola's incubation period is two to 21 days. In the wake of the scare on the seas, Texas Health Presbyterian shared news guidelines it had issued limiting staff's travel. From now on workers will not be permitted to board planes, ships or trains for 21 days after entering a room with an infected patient."
Better very late than never, I guess...