Ebola’s Grand Challenge: Expect the best, prepare for the worst

Ebola’s Grand Challenge: Expect the best, prepare for the worst

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Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic in Monrovia, Liberia on Sept 22. 2014. PPE is their primary protection, but it is also the greatest source of stress. / Morgana Wingard, USAID
Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic in Monrovia, Liberia on Sept 22. 2014. PPE is their primary protection, but it is also the greatest source of stress. / Morgana Wingard, USAID

WASHINGTON, October 12, 2014 — The CDC has confirmed that a female nurse at Texas Health Presbyterian Hospital in Dallas has tested positive for Ebola following preliminary testa. Confirmation will be announced later today.

The nurse, still unnamed, helped care for Thomas Eric Duncan, the Liberian who died from Ebola in Texas. Reporting that she had a low-grade fever Friday night, she was immediately isolated.

This case is the second Ebola diagnosis in the United States. A “close contact” of the nurse has been “proactively” placed in isolation, Texas Health Resources chief clinical officer Dan Varga says.

Reports are that when Duncan was admitted for treatment, CDC protocols were in place and the nurse was wearing protective gear as prescribed by the CDC, including gown, gloves, mask and shield. The nurse was was on the care team that had “extensive contract” with Thomas, said Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention.

“At some point, there was a breach in protocol, and that breach in protocol resulted in this infection,” he said at an Atlanta news conference Sunday.

Reports that the nurse “breached” the protocols in caring for Thomas are based on excluding other ways that she could have been infected.

Laypersons may immediately think that a “breach” would be a tear in protective clothing, such as seen in the movie Outbreak (Dustin Hoffman). However, the most vulnerable point of the CDC protocol is when the health care worker is removing their gown, gloves, mask and shield, according to Dr. William Schaffner, Department of Medicine at Vanderbilt University.

According to Schaffner, a buddy system is essential at this point in the process to make sure that the person disrobing does so slowly and deliberately to ensure that they do not infect themselves. The buddy system should aso be used by nurses, doctors, janitors — anyone who comes in contact with the infected patient. Basically, one person cares for the infected while a second watches for “breaches” according to Dr. Gavin Macgregor-Skinner, an infectious disease expert.

Dr. Macgregor-Skinner warns that we are not prepared as a nation for long-term patient care of an infected person. He is saying that hospitals, first responders, mortuaries, lab technicians and aides all need to have increased management training on protocols.

There need to be clearly defined steps to not only recognize the disease, but once the disease is suspected, to specify how the patient will be transported to a bio-containment area, along with the route that will be taken to make that transfer.

What protocols will be put into place to ensure — from first diagnosis to recovery, or if the patient dies, after death — to protect everyone the patient may come in contact with, or everyone who may come in contact with everything from blood samples sent to the lab to the patient’s sheets?

The U.S. government’s recent purchase of 160,000 hazmat suits designed specifically to defend against Ebola is provoking speculation that the government is more concerned than they should be with a disease that is “difficult” to contract. Or is it a manner of expecting the best, preparing for the worst?

A press release from Lakeland Industries:

Lakeland Industries, Inc. (LAKE), a leading global manufacturer of industrial protective clothing for industry, municipalities, healthcare and to first responders on the federal, state and local levels, today announced the global availability of its protective apparel for use in handling the Ebola virus. In response to the increasing demand for specialty protective suits to be worm by healthcare workers and others being exposed to Ebola, Lakeland is increasing its manufacturing capacity for these garments and includes proprietary processes for specialized seam sealing, a far superior technology for protecting against viral hazards than non-sealed products.

“Lakeland stands ready to join the fight against the spread of Ebola,” said Christopher J. Ryan, President and Chief Executive Officer of Lakeland Industries. “We understand the difficulty of getting appropriate products through a procurement system that in times of crisis favors availability over specification, and we hope our added capacity will help alleviate that problem. With the U.S. State Department alone putting out a bid for 160,000 suits, we encourage all protective apparel companies to increase their manufacturing capacity for sealed seam garments so that our industry can do its part in addressing this threat to global health.”

The government has also offered a $1 million prize for the best new design of a hazmat suit; the present suites are too bulky and difficult for healthcare officials to use.

The federal government is appealing to the public to invent the new hazmat suits and the United States Agency for International Development (USAID) has sent out an appeal for internet crowdsourcing to design a radical new anti-contamination suit that will lower the risk of health workers becoming infected.

USAID wants applications submitted immediately and any successful design will be awarded $1 million in funding. USAID has set a deadline of two months on the whole process. More can be learned about the Ebola Grand Challenge here

Dallas Fire Department hazmat teams have been tasked with decontaminating the public areas of the stricken health care worker’s apartment complex and her car, according to Mayor Mike Rawlings.

Police are keeping people out of the area and are talking to residents nearby.

“We have knocked on every door on that block,” the mayor said.

Hazardous materials units have also cleaned out the nurse’s car and will work on her apartment Sunday.

The reporting of this second case of Ebola is not surprising, according to Dr. Frank Esper who appeared this morning on CNN’s New Day:

I think we’ve always expected that there may be another individual who will come down with the Ebola from the transmission of this one particular person, and we always felt that it was going to likely be one of his close contacts or one of the health care workers, because that’s the way this virus works.

Esper said Texas officials have been keeping a close eye on people who had contact with Duncan.

“I will tell you that the fact that we identified this individual so quickly is actually to me a sign that the system is working,” he added.

No reports can be found as to other persons who may have treated Duncan when he first sought medical care on September 25, 2014 — when Duncan was already very sick — and we can assume that full CDC protocols were not used during that first hospital visit.

There are no reports on the state of health of the people on the plane with Duncan, or whom he may have come in contact with during that flight.

Sept. 19 — Duncan flies from Liberia on Brussels Airlines flight to Belgium.

Sept. 20 — Duncan flies United Airlines to Dulles Airport near Washington, and then to Dallas-Fort Worth Airport.

Sept. 24 — First symptoms of Ebola present..

Sept. 25 — Seeks medical care at hospital’s emergency room for fever and abdominal pain; tells nurse he had traveled from Africa.

Sept. 28 — Returns to hospital by ambulance and is placed in isolation because doctors suspect Ebola.

Sept. 30 — Tests positive for Ebola.

Oct. 2 — Members of the family with whom Duncan was staying are confined to their home under armed guard.

Oct. 3 — Health officials say they are monitoring the health of nearly 50 people who had varying degrees of contact with Duncan, including 10 considered at higher risk. None has shown symptoms.

Oct. 4 — Hospital downgrades his condition from serious to critical.

Oct. 7 — Hospital confirms Duncan is on a breathing machine and kidney dialysis.

Oct. 8 — Duncan dies at the hospital.

Oct. 10 — The Texas Department of State Health Services announces that Duncan’s remains have been cremated.

October 10 – A nurse who took care of Duncan reports that she has a low-grade fever.

October 12 – It is reported that the nurse has tested positive for Ebola in preliminary testing.

It seems that the line between caution and panic may be thinning more rapidly than we would like. Then we have fools like this:

CNN.com Contributed to this report 

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