Thursday, September 4, 2014

EBOLA: Simon Sez You Need To Wake The Eff Up

Just a little more sunshine for your fund of How Bad It Really Is:


The hospital in Liberia where three American aid workers got sick with Ebola has been overwhelmed by a surge in patients and doesn't have enough hazard suits and other supplies to keep doctors and nurses safe, a missionary couple told The Associated Press on Wednesday.

The latest infection -- of Rick Sacra, a doctor who wasn't even working in the hospital's Ebola unit -- shows just how critical protective gear is to containing the deadly epidemic, and how charities alone can't handle the response, they said.

About 250 staffers at the hospital use thousands of disposable protective suits each week, but that's not enough to fully protect the doctors and nurses who must screen people entering the emergency room or treat patients outside the 50-bed Ebola isolation unit, they said.

"We don't have enough personal protective safety equipment to adequately be able to safely diagnose if a patient has Ebola. So they are putting themselves at risk," David Writebol said.

Sacra, 51, a doctor from suburban Boston who spent 15 years working at the hospital, felt compelled to return despite these challenges. As soon as he heard that Dr. Kent Brantly and Nancy Writebol were sick, Sacra called and said "I'm ready to go," SIM President Bruce Johnson said.

Sacra's job was to deliver babies and care for patients who were not infected with Ebola. He helped write the protocols for handling Ebola, his brother Doug said, and he followed all the protections, said Will Elthick, the group's operations director in Liberia.

But Sacra got infected nonetheless by the virus that has killed more than 1,900 people and sickened 3,500 in five West African nations.

The disease is spreading faster than the response for lack of protective gear and caregivers, said Tom Kenyon of the U.S. Centers for Disease Control and Prevention. At least $600 million is urgently needed to provide these tools and extra hazard pay so that more doctors and nurses are willing to risk their lives, the World Health Organization said Wednesday.

Health care workers at other West African hospitals have gone on strike demanding more protections, the Writebols said.

"They see colleagues who have fallen. They don't want that to happen to them. But they are saying, 'I can't go to work safely until there is personal protective equipment available -- the right gear, the right procedures in place. And then, if they don't go to work, are they going to get paid?" David Writebol said.

The Writebols left Charlotte for Africa several years ago; David helped with the hospital's technology while Nancy helped dress and disinfect people entering and leaving the Ebola unit at ELWA, which stands for Eternal Love Winning Africa.

Liberians were already struggling to survive when they got there, but with Ebola it's chaos — the number of patients is surging, finding food and supplies is more costly, schools are closed and people with common injuries or even mothers in childbirth can't get care.

Ebola has "overwhelmed the supply chain," David Writebol said. "They can't get equipment in because there aren't any regular flights coming in. Same thing with aid workers from the international community. There are only a limited number of seats available to come into Liberia. ... That's one of the biggest problems -- getting medicine, protective gear and supplies for health care workers who are there."

Nancy Writebol said people who showed up at the emergency room with symptoms were ushered into triage. But health workers were sometimes exposed as they screened patients who may not have known or advertised that they were carrying the virus.

And sometimes, the sick would leave before finding out if they had Ebola. "Those are the people you really worry about going back into the community, because if they are sick with Ebola, it will ultimately spread," she said.

Sacra immediately got tested for Ebola after coming down with a temperature, and like his colleagues, went into isolation to avoid spreading the virus, his brother Doug Sacra told the AP.
Some other doctors haven't been so rigorous.

The WHO announced today that a doctor in southern Nigeria was exposed by a man who evaded surveillance efforts, and then in turn exposed dozens of others by continuing to treat patients after he became ill. Before he died, his family and church members laid their hands on his body in a healing ritual.

Now his widow and sister are sick and about 60 others in the city of Port Harcourt are under surveillance, the agency said.

Sacra, who left his family at home for this latest trip to Africa, was in good spirits Wednesday and able to send emails, Elthick said. That could mean he's physically well enough to be evacuated.
His wife, Debbie, said in a statement that she's focusing on her husband, but she said "Rick would want me to urge you to remember that there are many people in Liberia who are suffering in this epidemic and others who are not receiving standard health care because clinics and hospitals have been forced to close.

"West Africa is on the verge of a humanitarian crisis, and the world needs to respond compassionately and generously," she said.

It's not clear where Sacra would be treated in the U.S. Experts say any fully-equipped hospital that follows safety protocols could prevent an American outbreak while caring for an Ebola patient. But there are four high-level isolation units designed especially to handle dreaded infectious diseases.

The largest is at the Nebraska Medical Center in Omaha, which was told to prepare to receive a patient, but they were told the same thing before Brantly and Writebol were evacuated instead to Emory University Hospital in Atlanta, medical center spokesman Taylor Wilson said Wednesday.
 The other two units are National Institutes of Health facilities in Maryland and Montana.

So to recap:

* one facility, with but a modest patient capacity, goes through "thousands" of those suits weekly
* the hospitals are out of the suits, routinely, to provide basic protection in order to limit the further spread of the disease and keep staff alive
* the staff at those hospitals are bright enough to say "F--k no!" when asked to work without the suits
* the do-gooders coming in from outside the countries affected aren't that bright
* some staff members, after becoming infected, are becoming Typhoid Marys and actually propagating the spread themselves by wanton indifference to reality
* patients leave before diagnosis and quarantine, guaranteeing further spread indefinitely
* there are a total of four facilities in the entire US capable of properly handling Ebola patients without spreading the disease and making it worse

Which I've far from vaguely hinted at for a few weeks now, despite the "it can't happen here" BS being spewed from the White House, CDC, WHO, and every media jackass in creation.

(BTW, nota bene that the NSC adviser for this crisis, Gayle Smith, is precisely such a medically ignorant media jackass, and Special Adviser To The President, and who has noted that contrary to the requests from actual doctors from Medicins Sans Frontieres, who've been on the scene, and requested bio-incident response teams, Ms. Smith's extensive experience from a lifetime background of journalism school, reporting from African hotels, and poverty pimping on Africa through successive Democrat administrations and multinational boards and such, has led to the recommendation that we ignore the requests of medical professionals, and not risk testing our capabilities by sending our people to the hot zone, but rather just send them more boxes of those disposable suits. Either because our precautions are suspected of being ineffective as well, or because she knows we'll be needing those teams in NYC and Atlanta all too soon, and helping to guarantee that reality by waiting to face the problem until it walks onto our own front porch.

(I can count on the fingers of my third hand the number of times, when some serious question arose, anyone intelligent replied, "Quick, let's get a news reporter to tell us what's really happening."
But the current administration actually puts them in charge of that. What could possibly go wrong?)

But hey, cheer up:
New numbers  are up, as of September 3rd:

3500+ cases, 1900+ deaths

Note the official transition to the "plus" sign, to scientifically indicate "we have no fucking idea anymore", along with the notably sharper-than-expected upward trend of both categories since the tally on 8/26/2014. It's transitioning from an upward curve to a more vertical spike.

If this still isn't on your dashboard of things to consider yet, the next step is when lights start flashing on the instrument panel, and strange noises and smoke begin to emanate from under the hood.

"Farewell and adieu to you fair Spanish ladies..."


Pakkinpoppa said...

So, what's the good news?

Aesop said...

That if you have a cabin or farm in the country to relocate to for the next six to twelve months, without venturing out, and go there now,this will all be a total non-event for you.

boyd said...

Isn't this;
" Experts say any fully-equipped hospital that follows safety protocols could prevent an American outbreak while caring for an Ebola patient. But there are four high-level isolation units designed especially to handle dreaded infectious diseases."

a contradiction of this;
"there are a total of four facilities in the entire US capable of properly handling Ebola patients without spreading the disease and making it worse"

? -Boyd

Aesop said...

You can handle one or two Ebola patients. But at most hospitals, that would necessitate shutting down much or all of the hospital in question, because of risks of cross-contamination of visitors, other patients, and staff in common areas.

The four infectious disease wards (in GA, MD, MT, and KS or NE - I forget which) are purpose-built to not cross-contaminate everything else at their facility, though engineering safeguards and physical access controls. You don't want to be carting infectious patients down public hallways for imaging, lab tests, etc., nor hauling the prodigious amount of hazmat waste generated, etc. If one custodian were to drop an Ebola bag, and it rips or spills, that section of the building is now contaminated until it's cleaned, and the potential for further exposure goes way up.

If most any of the hospitals without such a dedicated unit tried to care for as many as 10 patients, they would have to shut down the entire rest of the hospital, which means no ER, no ICU, no surgery, no nothing, just as if you'd blown it up. And it would be infectious until it had been decontaminated top to bottom, including the air handling system and the plumbing, or else risk a later re-infection.

So that would deprive every other patient in the community of the entire resource, and force them to overcrowd other hospitals. We don't have that kind of excess capacity anywhere, so this would be like all the people on a sinking ship trying to get onto one lifeboat: it swamps, and people die.

That's why the Ebola care centers in Africa are separate places from the regular hospitals whenever possible, and why they're made of plastic sheeting: when they're finished with them, they just set them on fire. That's fine for a few rolls of plastic and some support piping, but not so good for a $100M mid-size or larger modern medical center.

Boyd said...

"That's why the Ebola care centers in Africa are separate places from the regular hospitals whenever possible, and why they're made of plastic sheeting: when they're finished with them, they just set them on fire. That's fine for a few rolls of plastic and some support piping, but not so good for a $100M mid-size or larger modern medical center. "

Maybe you're exaggerating? It's great that Africa is getting lots of temporary fast containment space and it makes sense that fire afterword could be used to dispose of them. But... that doesn't mean that standard disinfection (bleach) doesn't work on facilities housing ebola patients. I agree that this is serious, all these facts matter.

Aesop said...

Sure, they can disinfect them.
After discarding carpeting, upholstered furniture, and the like. And don't forget cleaning and disinfecting the plumbing, including pipe traps, and the entire air handling system for the facility. It would make an asbestos removal look like a picnic, and they'd be closed for months.

Look around your house.
Imagine it sprayed and splattered with coughed on, vomited on, and diarrhea-ed blood-infected "material".
All full of Ebola virus.

Now tell me what you'd do with it afterwards.

Now tell me what you'd do with it afterwards, knowing that it would see thousands of visitors annually, and that any lapse in infection control would result not only in a potential new outbreak, but an eight-figure lawsuit, by an unknowable number of plaintiffs, and a fresh round of national news stories about how you're running "Ebola Central Hospital".

Hospital administrators are understandably not too keen on any of that, and will tell the CDC "Thanks for playing, and we have some lovely parting gifts for you, but no way on hell are we going there." They'll probably close their doors first.

So you'd lose the hospital anyways, and still have no place to put Ebola victims.

Which is just great, if we start getting victims by the dozen or score instead of 1 or 2 total.

The driving consideration is how many people you're talking about treating.
No one has problem with 1 or 2.
And no one, not even those dedicated wards, can handle 50.

Once we hit that point, we're Liberia.

Boyd said...

Aesop, didn't see your replies here when I commented at BRM. Epidemics change the rules at hospitals, patients today are triaged in the ER (where chairs are plastic and floors are linoleum) that would be moved to tents outside in an emergency. I'm not downplaying any of this. It is actually so important that we have to get facts like this -right- and we have to maintain perspective.

Sorry if you took exception to my question about contradiction, I understand you did contradict the expert because you disagree'd with him. That wasn't obvious to a new reader of your blog.

Aesop said...

Understood, there's a lot going on, and I apologize for getting testy about this.

And yes, tents outside is the notional "plan" where I've worked too.
So an obvious leading question is, has Dallas THP set up a tent outside yet, and how and where do you sort out the "possible Ebola" patients from the "I broke my arm" patients, to avoid killing them all by crossing the streams?

Even here, they have no effing clue, because evidently no one has ever thought about that in advance.

Including the CDC.

Oh, and our chairs are not plastic. The ones outside will be, but once someone pukes or squirts diarrhea on one of the regular ones, the point is moot: it's hazmat, and has to be burned.
The front lobby (not the ER waiting room) is half carpeted.
Most of the visitors' chairs outside the ER are cloth and upholstered padding.

So you can see why the "any hospital can handle this" nonsense from know-nothing talking heads is disinformation, not news you can use.

A paltry 20 Ebola patients in any city would cripple healthcare, and provoke a crisis.

And we've had a nursing shortage for 25 years, so pulling ad hoc Ebola Treatment Centers out of anyone's hat, with no staff, and no one responsible for finding it, will just make them large open-air morgues.

Like in Monrovia.

That's before I get to finding doctors, supplies, pharmacy, lab,running water, sanitation, and actually mortuary services and disposal lined up, plus a thousand other details.

It would like trying to do the Normandy D-Day invasion on the fly, by just sending everyone to France on a boat, and hoping somehow it would all work out.

The casualty count is going to be about identical too.