Monday, October 13, 2014

Rose Fertilizer, By The Numbers

Despite being shelled for trying to blame the victim in the second Dallas Ebola case, the CDC minions are ceaselessly flailing to try and find a way to deflect the blame for their foolish and deficient policies, and try to put it on someone else. (Someone in full isolation and facing an imminent death would be ideal for the purpose, evidently.) Currently they're attempting to lie-splain that different procedures were followed at different times, and that therefore "See! Not Our Fault!"

So to help folks at home out, CNN has helpfully explained the CDC's hospital protocol for dealing with Ebola patients. So I thought some illustrative commentary would improve the information conveyed.

Hospital protocols, by the numbers: CDC, via CNN:

(CNN) -- First, a Texas hospital came under fire for releasing a sick Liberian man without testing him for Ebola. He later became the first person diagnosed with Ebola in the United States and died from the virus.
Then a nurse who treated the man at the same hospital also came down with Ebola. A top health official said a "breach in protocol" led to that infection.
So what's the protocol for health care workers if they suspect a patient has the virus that has already killed more than 4,000 people in West Africa?
Go through the checklist
Signs of an Ebola infection include fever, headache, vomiting, diarrhea, muscle pain or bleeding, according to the Centers for Disease Control and Prevention.

But a key clue is whether the person traveled to an Ebola-affected area -- such as Sierra Leone, Liberia or Guinea -- in the past three weeks.
That's because the symptoms of Ebola can take anywhere from two to 21 days to show up.
Focusing on this key clue will ensure that when patients show up with no African travel, and get infected due to exposure to someone else with Ebola, their diagnosis will be missed, just as Duncan's initial one was. Brilliant!
Isolate the patient
Once Ebola is suspected, the patient should get his or own room, with a private bathroom, the CDC said.

In twenty years of nursing, I've never seen so much as ONE ER patient room with a private bathroom. Nor even heard of one such.
And the door to the hallway should remain closed.
And at some point, it'll have to be opened. There goes any containment.
Hospitals should maintain a log of everyone who enters the room, the agency said.
Fair enough. That should add more time delay in care every time someone has to enter the room, but I absolutely grant the point. Of course, we'll also have to note that we should probably include them in the list of PEOPLE WE SPECIFICALLY MONITOR FOR 21 DAYS AFTER EXPOSURE, AND ISOLATE UNTIL CLEAR unlike the nurse in Dallas who was considered near-zero risk. Oopsie.
It's also a good idea to keep someone stationed at the patient's door to make sure everyone going in is wearing the right protective equipment.
Because we always have a spare person with nothing better to do but be a door guard. And of course, they'll need to be fully suited up too, since they'll be sitting RIGHT NEXT TO THE DOOR OF THE MOST INFECTIOUS PATIENT IN THE HOSPITAL. I'm sure that'll help motivate our lower paid employees.
Get the right gear
At the very least, those who enter the patient's room should wear gloves, a gown, eye protection and a face mask.
A "gown" includes total bullshit tissue-paper thin cover-ups, fine for relatively straightforward care for, say, a TB patient. Not so much good for someone with Ebola, and vomiting blood or squirting diarrhea.
Sometimes the situation calls for more precautions, such as wearing disposable shoe covers, leg covers and two layers of gloves.
"Sometimes"?? "Sometimes" being anytime the patient has Ebola, and you want to survive. Especially if they have vomiting or diarrhea, and don't want infectious puke and shit on your shoes, socks, feet, car mats, or the carpeting at home. Not to mention on the public bus, train, or subways, the cafeteria, and the staff break room, plus all over the hospital from your work area to the employee exit.
Those extra steps are needed if there is vomit, human waste or "copious amounts of blood" in the room, the CDC said.
In other words, if an Ebola patient exhibits common Ebola symptoms. Duh. Thanks for clearing that up.
Know the right order
It's not enough to have protective clothing; putting it on in the right order is just as important.
As my mother observed to me when I was three, in covering that shoes and socks don't go on in that order either.
"The dressing and undressing of (protective wear) should be supervised by another trained member of the team," the World Health Organization advises.
After donning scrubs, health care workers should put on either boots or closed, water-resistant shoes with overshoes.
Then a waterproof gown should go over the scrubs. If one isn't available, wear a waterproof apron over a gown.
So NOW the gown has to be "waterproof". Nice. probably wanted to note that right off. Someone should probably order some of those at some point then, huh?
Next come the face mask, goggles and a head cover, if available.
And if a head cover is "not available"?? WTF? Just skip it, because bloody sputum, vomitus, etc., will never splash that high? I've only had people with simple nausea projectile puke on me all the way to the crown of my head, from the bed, and they weren't even trying to puke their guts out literally like an Ebola patient. Oh, and we've never stocked ANY head covers for any other infections, so either we, or the patient, is S.O.L. until someone starts ordering hoods too.
Finally, after washing their hands, health care workers should put on gloves over the sleeves' cuffs.
Um, NO, Cupcake. This is why reporters make lousy doctors and nurses. They should put gloves on UNDER the cuffs, so liquids don't drip down the outer sleeve and inside the glove, onto the hands. THEN they should ALSO put on another set of gloves over the inner pair, this time OVER the sleeves. Maybe you could watch your own TV news coverage.
When it's time to take the gear off, extreme care must be taken to avoid contaminating regular clothing, eyes or mucous membranes.
CDC Director Dr. Tom Frieden said gear removal is a "major potential area for risk."
"When you have gone into and potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material touching you and being then on your clothes or face or skin and leading to an infection is critically important and not easy to do right," Frieden said.
And praytell, WHEREINHELL are they supposed to be doing this deliberate and meticulous de-gowning and decontamination? Y'see, you geniuses forgot that it's easy to get a clean person into a dirty room, but it's a fuck-all lot of good if you have nowhere for them to go to get OUT, other that walking outside, and contaminating the ENTIRE AREA YOU WERE TRYING KEEP UNEXPOSED BY CLOSING THAT EFFING DOOR!
(This is the point at which the supergenius reporter, and the CDC jackass who came up with this, should slap themselves in the forehead and say "OMG! We FORGOT that part!")
Total number of ERs (or anyplace not one of the four Infectious Disease BL4 wards) that has a decon/undressing room contiguous and convenient for patient care? Near zero. Some few may have a small alcove immediately outside a room, but seldom are they large enough to permit a full hazmat de-gowning in meticulous order, or have room for another staff member to assist in the process.
So we'll get right on rebuilding every hospital in the country just for Ebola. Obamacare has left us with TONS of extra money for that.
(NOT! We've been laying off staff for two years since O-care hit us. Just in time for this little plague soiree.)
Keep visitors out
It may seem obvious, but it's important to keep visitors away from the patient's room.
"Exceptions may be considered on a case-by-case basis for those who are essential for the patient's well-being," the CDC said.
Unless it's the adult parent of a minor child, I have never met the visitor whose presence is "essential for the patient's well-being". I know what those words mean separately, but together they convey no useful thought or actual thing.
If your family member has Ebola, this is what God and Bill Gates made the Internet and Skype for. You want to video-conference with your critically-ill loved one, go right on ahead. If I'm that nurse, I'll hand them your smartphone, and even make sure it's plugged into the charger for you. You can always buy another one.
Keeping visitors away doesn't just protect them; it also protects hospital workers, patients and others in case the visitor may have contracted Ebola, too.
Those who do visit should be screened for fever and other symptoms.
All these procedures may seem tedious, but every precaution matters, Frieden said.
"The care of Ebola can be done safely, but it's hard to do it safely. It requires meticulous and scrupulous attention to infection control, and even a single, innocent, inadvertent slip can result in contamination."

Which, as noted earlier, pretty well totally undermines your happy horseshit yesterday, last week, and last month about how "hard" Ebola is to contract, and how "highly unlikely" its spread was.
So CDC Director Frieden can spin one pile of BS or the other, but he can't squirt out two piles on either end of the spectrum of mutual contradiction, and have BOTH of them be true simultaneously.
Thus, as Charles Laughton famously asked Marlene Dietrich's character in Witness For the Prosecution, "Were you lying then, or are you lying now, or are you not in fact a chronic and habitual LIAR?!?"

Your ball, Frieden.


Anonymous said...

"Patients can pass on the virus from 1.2 to 7 days after becoming infected."

Doesn't sound as nice as the "only infectious when symptomatic" I've heard here and there, but it's better to learn some things beforehand.

Now working on Plan B, which isn't very cheery considering I'm smack in the middle of the EU...disarmed and surrounded by 500 million potential self-digesting petrie dishes waiting for a culture.

Best Regards,
Stefan v

Anonymous said...

"minions are ceaselessly flailing to try and find a way to deflect the blame for their foolish and deficient policies"

Just like during the 07/08 economic collapse, they blamed it on the working man, instead of their Too Big Too Jail.

Susanamantha said...

CDC Boss man should leave Ebola to a real expert and go back to banning salt, transfats, and large Cokes in cities with Little Nazi mayors.

Only government could f--- this up as badly.

Anonymous said...

The decontam showers at our local hospital are outdoors, by the ambulance bay, so a suited nurse will have to walk all the way through the ED to get cleaned up.

I foresee problems in wintertime.

Anonymous said...


This report:
Is quite consistent with my PhD work in aerosols and resp infection with influenza.

I graduated before Ebola, but well I remember the crazy Dutchman going into Zaire. Several of us followed his work breathlessly and cheered him on.

Also I well remember the CDC purges in the '80's of everyone who had field experience with level 4 infectious agents. So what we have today are Johnny Come Lately know nothings.

Thankfully, I am now long retired. Best to you.


GamegetterII said...

My Doc said today that he's already seeing flu cases,and they are confirmed by lab work influenza cases.
It's only mid Oct.
What happens when ER's start seeing "flu" patients who don't actually have the flu-they have ebola?
I see a giant clusterf*ck coming.
All it would take is one misdiagnosed case-like the guy in Dallas-that goes home on the subway in NYC,and it's game over. No way to contain it then.
They can't contain it now,I don't see what makes the morons at the CDC think they can contain ebloa,other than too many morons with zero medical background who just believe the bullsh*t they are being fed by the "upper management" of the CDC.

Anonymous said...

Looks like the hospitals are using level 3 protective gear for a level 4 virus.

Robert What? said...

I'm not a medical worker, but even I can tell the CDC guidelines were written by someone who has never worked in a hospital, and whose medical knowledge come solely from a book.

Anonymous said...

KU Hospital testing patient for Ebola virus

Thought this might be of interest to you.

Anonymous said...

I'm sure she is fine.

Robin Datta said...

Horsespittles "know" how to control Ebola. As a retired ED doc, I "know" how to do every kind of surgery, from the scalp to the soles.

Leaving it to all the horsespittles to control Ebola is like depending on me to do those surgeries: FUBAR.

Tobias said...

I am observing a training of the Homeland Response force national guard in two weeks. Not that they have been mobilized but in eastern Washington we do have the resources to set up a 36 bed mobile hospital and have MOUs to use nursing homes as overflow facilities. There are plans in place. I'm not sure how they would work in a real emergency but they are there. Via volunteering for the FEMA Medical Reserve Corp there are resources out there for anyone who wants training.