Pandemic Survival

**LowKey** · 10-01-2014, 06:19 PM

It's here. Now. 1 in the hospital and 18 under observation including 5 school age children. In Texas? I would have expected it first in NY, Boston or LA.

**kyratshooter** · 10-01-2014, 07:18 PM

They are now reporting a second confirmed case associated with the first.

There is a 10,000 strong Nigerian community in Dallas and their airport is an international hub. That is a "perfect storm" situation.

That a person just returning from Nigeria (he informed them of that) was treated for flu like symptoms and returned home is criminal negligence on the part of the ER doctor.

I will bet that the entire hospital staff is in lynch mob mode!

Especially the lab!!!

They would have isolated his specimens, used hazmat suits and had specific protocols for biohazard disposal if warned. Now everyone from the phlebotomy staff, the candy striper that carried the specimens to the lab, all the techs, and the janitorial staff have to consider themselves EXPOSED.

**crashdive123** · 10-01-2014, 07:30 PM

Epidemiology 101......

Do not allow travel from areas where there is an outbreak like ebola. Too bad we have community organizers running things, whose advisers are afraid to offer a contrary view to that of the king.

**canid** · 10-01-2014, 08:31 PM

Originally Posted by kyratshooter

They are now reporting a second confirmed case associated with the first.
That a person just returning from Nigeria (he informed them of that) was treated for flu like symptoms and returned home is criminal negligence on the part of the ER doctor.

That is a terrible shame, to be sure.

I will bet that the entire hospital staff is in lynch mob mode!

This I doubt. I have no doubt that there will be some amount of this understandable sentiment, but I'm willing to bet that much of the staff and even a flock of medical professionals form outside will line up for the chance to get first hand experience with a novel tropical infectious disease which has never (aside from a non-human-pathogenic strain seen only in a primate research facility) been seen outside of it's home continent before this outbreak, with full consideration for the importance and duty of making sure things return to that prior norm.

I am always willing to consider that I may be wrong, but this is not the first time in this very outbreak that 'not here' has slowed the response. It happened in Nigeria, and that is the first country involved which has seemed by medical protocols to have stopped it's outbreak. We are far better suited to handle this even than they and of course my prayers are with all those currently concerned.

Sorry for the rant.

**kyratshooter** · 10-01-2014, 08:56 PM

Nope Canid, most hospital staff is present to help, and readily do so using the proper precautions, but do not feel compelled to have some one else needlessly sacrifice their lives.

My wife was a long term Medical professional and these kinds of things make them fighting mad!

By not being properly warned they came in direct contact with EBOLA, then quite possibly took it home to their husbands, wives and children.

This complication, like most others, could have been stopped by a physician following proper protocols. This outbreak can be directly laid at the feet of a careless MD and they are being very careful NOT to release the name.

**canid** · 10-01-2014, 09:04 PM

Every medical professional in the entire world is at risk of contacting ebolavirus and any number of other infectious diseases at all times, and particularly so during any active international outbreak, full stop. You find me the medical professional who doesn't already know that and I'll recommend a change of career.

This is not to say I don't understand; I can't stand to see a potential and anticipatable crisis mismanaged either.

**Rick** · 10-02-2014, 07:15 AM

The article I read said he informed a nurse of his travels and he/she failed to report it. All it takes is one person too busy to not make the connection. As for hazmat suits, the CDC has been recommending to hospitals over the last month that they do NOT use them. Their position is the use of unfamiliar equipment stands a better chance of cross contamination and infection. Since ebola is not air borne the use of gown, gloves and surgical mask is sufficient. Here's an article in the Annals of Medicine that discusses precautions.

"The CDC recommends placing patients with suspected or confirmed Ebola in a single-patient room and instituting contact and droplet precautions (1). These entail donning a fluid-impermeable gown, gloves, a surgical mask, and either goggles or a face shield. If the patient has “copious” secretions, the CDC also recommends shoe and leg coverings. If an aerosol-generating procedure is planned (such as intubation or bronchoscopy), the CDC recommends wearing an N95 mask and placing the patient in a negative-pressure room. Despite this guidance, many hospitals are planning to place all patients in negative-pressure rooms at all times, to compel all personnel to wear full-body hazardous material (HazMat) suits, and to require N95 masks or powered air-purifying respirators rather than surgical masks at all times.

Hospitals' decisions to maximize precautions are understandable given the horrific mortality of this disease and reports of ongoing transmission in African hospitals. Fears among U.S. providers are undoubtedly further spurred by the dramatic footage of ambulance workers in Madrid, Spain, and Atlanta, Georgia, wearing full-body HazMat suits and personal respirators to transport infected patients. However, these excessive measures are unwarranted...

...Exceeding these recommendations may paradoxically increase risk. Introducing new and unfamiliar forms of personal protective equipment could lead to self-contamination during removal of such gear. Requiring HazMat suits and respirators will probably decrease the frequency of provider–patient contacts, inhibit providers' ability to examine patients, and curtail the use of diagnostic tests. Patients without Ebola may also inadvertently be harmed because Ebola precautions will be required for all suspected cases even though malaria and other infections are more likely in patients from West Africa presenting with fever. Using extra gear inflates patients' and caregivers' anxiety levels, increases costs, and wastes valuable resources. More insidiously, requiring precautions that exceed the CDC's recommendations fans a culture of mistrust and cynicism about our nation's public health agency."

http://annals.org/article.aspx?articleid=1899515

**Rick** · 10-02-2014, 09:17 AM

Here's a quick checklist for supplies if anyone is interested. We have some folks on here that are new to planning so this is more for them. The list mentions an electrolyte replacement for dehydration as the result of vomiting or diarrhea. An easy one to make and remember is 1 quart of water, a handful of molasses or honey (Just make sure it's real honey not that store bought crap) and a pinch of salt.

http://healthvermont.gov/panflu/docu...t-combined.pdf

**Rick** · 10-02-2014, 09:29 AM

Up to 80 people are now being watched in Texas.

http://www.bbc.com/news/world-us-canada-29462431

And some responsible information:

http://time.com/3451161/the-good-new...la-in-america/

**crashdive123** · 10-02-2014, 04:32 PM

The thing that concerns me the most is that we are just one mutation away from it becoming airborne.

http://www.dailymail.co.uk/news/arti...-airborne.html

**canid** · 10-02-2014, 04:47 PM

That has always been the case, and not only for ebolavirus. One or a handful of mutations.

**Rick** · 10-02-2014, 07:04 PM

It it's any consolation, it has not mutated in ten years. Of course, that doesn't meant it can't or won't only that it hasn't. Infectious disease is given an R0 value (R naught). The higher the R0 the faster the disease will spread. Measles, for example, has an R0 of 17-18 meaning that if one person has measles they are likely to infect 17-18 other people and those individuals will each infect another 17-18 people and so on. The reason is measles is both transmitted by air and can be contracted before the host exhibits any symptoms.

Ebola, on the other hand, has an R0 of 1-2. It's actually pretty hard to catch requiring direct contact with a patient that is showing symptoms AND you must come in contact with the patient's body fluids such as vomit, blood or other fluids. There is actually some pretty good literature being circulated on it at the moment.

**crashdive123** · 10-02-2014, 07:59 PM

Well, the opportunity certainly exists for spread from this patient. http://www.thegatewaypundit.com/2014...his-apartment/

**Rick** · 10-03-2014, 06:49 AM

There's no doubt the medical team hosed the pooch on this one. I've tried to put myself in the nurse's shoes and think he made some passing comment of having been to Nigeria, the nurse being very busy and not really processing what he had just said and you tend to look for the most obvious solution instead of some far fetched thingy. Flu would have been a natural diagnosis given where he was and his symptoms. So I don't necessarily blame them for having missed him the first time around. Medical folks are just people and they are prone to mistakes just like the rest of us. Unfortunately, some mistakes in that profession lead to death. At this point, I'm pretty confident they'll get a handle on it. I hope I'm not making a mistake thinking that.

**crashdive123** · 10-03-2014, 11:30 AM

Listening to the radio this morning....

Apparently a "clean-up" team was hired to clean the place where he was staying. After doing so, they came to the sudden realization (?) that they were not qualified nor equipped to remove the hazmat from the site so they left it. I believe that people are well meaning in this, but need to realize their limitations.

**Rick** · 10-03-2014, 11:34 AM

They guys were apparently short a transport permit that the state issues. The article I read said they only do the cleaning but not the transporting. They found out the permit had not yet been issued so they delayed the clean up until it can be transported.

"Brad Smith of the Cleaning Guys, which was hired to sanitize the apartment, said his company is ready to go but a permit issue has stopped them from entering the home. Smith says a specialized permit, which is handled by the state government, is needed to transport this type of unprecedented hazardous waste on Texas highways. Cleaning Guys specializes in hazmat and biohazard cleaning services, but it does not transport the materials.It's unclear how long it will take to get the proper permits.
"This is a unique situation," Smith said. "Once awarded, our hazmat teams will be allowed back inside to do their jobs."
Louise told CNN's Anderson Cooper that she used bleach to clean her apartment, "but it's not clear to me how systematic the cleaning was," Cooper said. "

http://www.kwch.com/news/health/clea...-home/28383914

**crashdive123** · 10-03-2014, 11:35 AM

Well, that's a little reassuring.

**Rick** · 10-03-2014, 11:37 AM

What's interesting to me is how little prepared we are even when we've handled some pretty serious past events. We are missing things left and right that should have been caught and handled on the front end. One could say live and learn but in this case you might not live to learn.