Ebola in the USA

[greg775]

Are you folks worried we've got our first case of Ebola here?

I was a little bothered that the hospital didn't give a f*** and keep the guy in there when he first showed up at the Dallas hospital. Seems as if he had contact with a lot of people but allegedly Ebola isn't the type of disease easily transmitted.

Anyhow, any of you health experts want to fill us in? Is Ebola a big deal in Africa (in terms of it spreading into a once in a lifetime killer disease)? Should Greg be worried here?

thanks in advance.

Edited October 2, 2014 by greg775

[justBLAZE]

Are you folks worried we've got our first case of Ebola here?

I was a little bothered that the hospital didn't give a f*** and keep the guy in there when he first showed up at the Dallas hospital. Seems as if he had contact with a lot of people but allegedly Ebola isn't the type of disease easily transmitted.

Anyhow, any of you health experts want to fill us in? Is Ebola a big deal in Africa (in terms of it spreading into a once in a lifetime killer disease)? Should Greg be worried here?

thanks in advance.

 

I guess it spreads by bodily fluids, not sure if 'sneezing' on someone would spread the disease.

[StrangeSox]

Yeah, it's carried in the droplets you'd sneeze out. Carried in sweat, too.

[EvilMonkey]

I am more pissed that this idiot knew he had it, or should have known he had it, when he got on the damn plane to come here. He put everyone he came in contact with at risk. And while the hospital misdiagnosed and let him go, you would think maybe he would have spoke up and said 'no, I just might have ebola, I just came from Liberia where I was holding an ebola patient in my arms.please look again'.

[StrangeSox]

I am more pissed that this idiot knew he had it, or should have known he had it, when he got on the damn plane to come here. He put everyone he came in contact with at risk. And while the hospital misdiagnosed and let him go, you would think maybe he would have spoke up and said 'no, I just might have ebola, I just came from Liberia where I was holding an ebola patient in my arms.please look again'.

 

I read that he was not symptomatic during his flight.

[NorthSideSox72]

I read that he was not symptomatic during his flight.

But can someone carrying it, without yet having outward symptoms, still transmit it?

 

Hemoragic fevers work fast, really fast. On the one hand that's a good thing historically, because the disease tends to blow itself out in short order when an outbreak occurs. But it also means someone can become a transmitter pretty fast - I just don't know if it happens before outward symptoms or not.

 

[StrangeSox]

But can someone carrying it, without yet having outward symptoms, still transmit it?

 

Hemoragic fevers work fast, really fast. On the one hand that's a good thing historically, because the disease tends to blow itself out in short order when an outbreak occurs. But it also means someone can become a transmitter pretty fast - I just don't know if it happens before outward symptoms or not.

 

On another board that I post at, there's a couple of people that are virologists, doctors, etc. including one person who is actively involved in the research and efforts in this latest case. They said that if the person is asymptomatic, there's a minimal risk of spreading the disease.

 

They also gave a possible explanation for how this was missed the first time around at the Dallas hospital:

 

According to reports, information was not successfully passed on among the staff treating him. That's a common occurrence in US hospitals, with their fragmented health care. It's as American as hospital-acquired infections and misguided end of life care.

 

It's not obvious to me, though, that he should have been tested under CDC guidelines, depending on just how minor his symptoms were at that point. Just being sick and having returned from Liberia isn't enough to warrant testing, according to the CDC. Personally, I think that's nuts. It's tied up with the notion that all Ebola testing should be done by the CDC (or now, by a handful of other labs) when any good hospital lab could do it themselves, faster and with less to-do. We're shopping an op-ed on this point right now.

 

In any case, the health department should have been notified, which I gather didn't happen. Oopsies.

[knightni]

The big question... Will there be a "Party in the USA" parody song made from this article topic?

 

No man can tell.

[EvilMonkey]

I read that he was not symptomatic during his flight.

The dude rode in a cab with a friend who had it to the hospital, carried her to the hospital from the cab and then sat with her outside because the hospital was full until she died. He had to at least have had an idea that he had it. And when he first showed up at the hospital, you would think that that word might have come out of his mouth at some time.

[EvilMonkey]

Just being sick and having returned from Liberia isn't enough to warrant testing, according to the CDC.

What? There can't be that many people coming here from Liberia of all places, who are sick. YES you test them or something. WTF is up with the CDC?

[StrangeSox]

The first step in the linked CDC flowchart is whether they have a fever of 101.5 or higher. If they don't, current guidelines are to not test. Maybe they didn't have a fever that high yet.

[StrangeSox]

The dude rode in a cab with a friend who had it to the hospital, carried her to the hospital from the cab and then sat with her outside because the hospital was full until she died. He had to at least have had an idea that he had it. And when he first showed up at the hospital, you would think that that word might have come out of his mouth at some time.

 

The person not being symptomatic on the flight was more about not knowing prior to boarding and, more importantly, thankfully limiting the potential for the disease spreading.

 

 

[knightni]

The doctors should have at least asked him questions before releasing him the first time.

 

"Have you been anywhere outside of the country recently?"

 

"Have you been around anyone who's been sick lately?"

 

 

 

 

[StrangeSox]

Even then, per the CDC guidelines, testing isn't necessarily indicated. It would depend on the type of contact/exposure, severity of the illness, lab findings and possible alternative diagnoses.

 

edit: which probably demonstrates a substantial flaw in their current guidelines. Per that other person I quoted, CDC wants to handle all Ebola testing themselves right now. Because of that, they need to find guidelines so that everyone who's been to Africa within the previous three weeks and goes to the hospital isn't being tested for EBV. I don't know how quick and expensive that testing is.

Edited October 2, 2014 by StrangeSox

[NorthSideSox72]

Even then, per the CDC guidelines, testing isn't necessarily indicated. It would depend on the type of contact/exposure, severity of the illness, lab findings and possible alternative diagnoses.

 

edit: which probably demonstrates a substantial flaw in their current guidelines. Per that other person I quoted, CDC wants to handle all Ebola testing themselves right now. Because of that, they need to find guidelines so that everyone who's been to Africa within the previous three weeks and goes to the hospital isn't being tested for EBV. I don't know how quick and expensive that testing is.

Not just that CDC insists on testing themselves. If a person has just travelled from a country that is an epicenter for an outbreak of something like this, they need to have bulletin-updated protocols sent to hospitals to override previous procedure. That should be obvious.

 

[StrangeSox]

The procedure is specifically for EBV outbreaks and includes branching paths based on potential EBV exposure. I don't know how many people fly from Sierra Leone, Liberia or Nigeria to the US and then go to the hospital for one reason or another within three weeks, but if it's a decent amount of people*, you need to find a way to screen out who actually should be tested.

 

*I don't know what sort of resources are available for EBV testing and what would count as enough people that testing all of them would overwhelm the system and create a backlog where more likely cases don't get tested quickly enough.

[StrangeSox]

To answer one of greg's questions in the op, yes this is a very big deal in Africa. Current projections are that the spread won't peak until January, and by that point 1.4 million people will have been infected. Last I read, the mortality rates for this particular strain of EBV were 50-60% reported but thought to be higher due to under-reporting in many areas.

 

Frontline had an episode on the outbreak a few weeks back.

[Balta1701]

The doctors should have at least asked him questions before releasing him the first time.

 

"Have you been anywhere outside of the country recently?"

 

"Have you been around anyone who's been sick lately?"

They did ask that by the reports I've read, but somehow that wasn't transmitted up the line enough to motivate actual testing, which should be an indictment of the hospital itself and no one else.

[Balta1701]

The procedure is specifically for EBV outbreaks and includes branching paths based on potential EBV exposure. I don't know how many people fly from Sierra Leone, Liberia or Nigeria to the US and then go to the hospital for one reason or another within three weeks, but if it's a decent amount of people*, you need to find a way to screen out who actually should be tested.

 

*I don't know what sort of resources are available for EBV testing and what would count as enough people that testing all of them would overwhelm the system and create a backlog where more likely cases don't get tested quickly enough.

The number who go to a hospital after traveling to those areas who are complaining of flu-like symptoms are going to be small enough that testing them all would be less effort than we're going through right now trying to track these people down.

 

There's no excuse for the hospital making this mistake, there's no way around it, someone f***ed up.

[Balta1701]

Not just that CDC insists on testing themselves. If a person has just travelled from a country that is an epicenter for an outbreak of something like this, they need to have bulletin-updated protocols sent to hospitals to override previous procedure. That should be obvious.

The CDC has put out several alerts with detailed procedures and links to more information over the past few months. These include procedures for recognizing symptoms, treatment and quarantine responses, how to deal with contaminated biological waste, and lots of other stuff.

 

The CDC isn't allowed to come in and take over every hospital in the country to make sure they listen.

[southsider2k5]

To answer one of greg's questions in the op, yes this is a very big deal in Africa. Current projections are that the spread won't peak until January, and by that point 1.4 million people will have been infected. Last I read, the mortality rates for this particular strain of EBV were 50-60% reported but thought to be higher due to under-reporting in many areas.

 

Frontline had an episode on the outbreak a few weeks back.

 

The Frontline Ep said 70% mortality rate in Africa. Who knows how much of that is the standard of medical care there, versus the actual strength of the virus.

[Balta1701]

The Frontline Ep said 70% mortality rate in Africa. Who knows how much of that is the standard of medical care there, versus the actual strength of the virus.

Just making an educated guess...so far it seems like a whole lot of it is the standard of medical care. Nigeria had a few cases crop up, they clamped down on them and the outbreak there as of now seems to have burned itself out with only a 40% mortality rate.

[NorthSideSox72]

The CDC has put out several alerts with detailed procedures and links to more information over the past few months. These include procedures for recognizing symptoms, treatment and quarantine responses, how to deal with contaminated biological waste, and lots of other stuff.

 

The CDC isn't allowed to come in and take over every hospital in the country to make sure they listen.

Well good, glad they have done that.

 

[Balta1701]

The procedure is specifically for EBV outbreaks and includes branching paths based on potential EBV exposure. I don't know how many people fly from Sierra Leone, Liberia or Nigeria to the US and then go to the hospital for one reason or another within three weeks, but if it's a decent amount of people*, you need to find a way to screen out who actually should be tested.

 

*I don't know what sort of resources are available for EBV testing and what would count as enough people that testing all of them would overwhelm the system and create a backlog where more likely cases don't get tested quickly enough.

I should also add, if "testing people who just flew from Africa for ebola who have symptoms similar to those of the flu" takes some time, quarantine them and test them for the flu. If that comes back positive, maybe you worry less.

[StrangeSox]

I should also add, if "testing people who just flew from Africa for ebola who have symptoms similar to those of the flu" takes some time, quarantine them and test them for the flu. If that comes back positive, maybe you worry less.

That is the protocol under the Ebola Virus Disease Algorithm for Returned Traveler that I linked earlier:

 

http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf

 

If they present with 101.5 degree fever or higher and have been to Ebola-infected areas within 21 days, the first steps are to isolate, increase disease spread precautions, and immediately notify the health department.

 

It seems like there were major chain of communication problems with the hospital, regardless of whether the CDC algorithm would ultimately have indicated that testing was necessary.