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Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas - Died

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Anderson Cooper on CNN television is reporting that he had an interview (that will be televised tonight) with a woman he is identifying as "Louise" (to protect her identity). Louise is one of the four individuals quarantined in the apartment where Thomas Eric Duncan stayed. Louise admits several very high risk exposures, including:

- Taking Mr. Duncan to the hospital on the evening of the 25th.
- Sleeping in the same bed as Mr. Duncan on the nights of the 26th and 27th.
- Sleeping on the same sheets on the nights of the 28th and 29th, after Mr. Duncan has been hospitalized.
- Folding up and bagging towels that Mr. Duncan used AFTER Mr. Duncan was admitted.

Louise claims the sheets are still on the bed, but that everyone has been instructed not to use the bed, and the towels are in a plastic bag in a corner of the apartment awaiting disposal instructions from the CDC.

I would assume Louise is probably the contact at the highest risk right now.


What is left to protect? The information is all over the internet and back again.

Amazing that the reporter is "protecting" the interviewee by using a different name, but when the US CDC is up front about not disclosing specific information about airline companies (for reasons IMO include preventing public boycott of the airline due to unfounded fears) - they are raked over the coals.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

This is a rapidly evolving situation. The latest reports say they are sending a team to the apartment right now.

I'd burn EVERYTHING, including the sheets, towels, and mattress.

Personally, since the woman is also reporting a shortage of food in the apartment, I'd evacuate them from the apartment using a team in biohazard suits, and let them serve their 21 days in a hospital or somewhere else where their necessities can be better met.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Well, the CDC is hardly inspiring trust. Just the other day, Tom Frieden, the director stated that only a "handful" of people who may have been in contact with the Thomas Duncan were being monotored. Now, today it is 100.
This from the agency that cannot keep track of its antrax and other dangerous pathogens.

http://www.washingtonpost.com/news/.../cdc-confirms-first-case-of-ebola-in-the-u-s/
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Well, the CDC is hardly inspiring trust. Just the other day, Tom Frieden, the director stated that only a "handful" of people who may have been in contact with the Thomas Duncan were being monotored. Now, today it is 100.
This from the agency that cannot keep track of its antrax and other dangerous pathogens.

http://www.washingtonpost.com/news/.../cdc-confirms-first-case-of-ebola-in-the-u-s/

The other day there were a handful.
Contact investigations always reveal more people to trace.
We are not hooked up to a camera and video live - information is going to change.
The excessive fear in this country brought on by media reports and the extremely unfortunate error in judgment at the hospital is what Frieden is trying very hard to address. The CDC does not want people reacting in fear - so many bad decisions are made when people are afraid.

CDC is not the entity that missed the case.
The responsible parties will be held accountable.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Curiosity.

I completely agree with you BUT it must be also acknowledged that fear is a very normal and human response. Rather than being papered over, fears need to be acknowledged where justified, then addressed fully and placed into context with information and transparency.

A parralel might be where an individual is told they may/do have a disease that could be fatal. There are a number of reaction processes, that are well established in the literature. I think individuals exposed to ebola probably go through the same process, as does the community around them...

A clinical psychologist can correct me, but in overview (as I understand it)

Fear and denial is the first response, usually followed by anger, followed by rationalisation, and then acceptance and resignation, and then concern for others (what will my family do if I am gone/ what if I expose them/ what if they have been exposed) and practically addressing the things that need doing to prepare for this eventuality.

People will react with fear. With something like ebola it is inevitable. What is key here is how those fears are addressed, through information, education and transparency... and time. Plenty of communication is needed about what is being done to manage the situation, minimise risks, what will be done if it has been spread to others, how they will be treated (and at whose cost), what will be done to further reduce risks of new cases escaping the system (so that any mistakes made do not happen again).

Everyone is on a learning curve and in new territory here.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Something else to consider, with Ebola, because of the short time frame, it is likely not possible for all the stages. So, Fear and denial the first stage, is also possibly the last stage.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Which is exactly why a considerable number of people who have been exposed will talk themselves into believing that 'it wont happen to them' and will carry on with life while believing that, until they cant deny it any longer. In the back of their minds the rationalisation will be 'what can I do just in case' driving people who can afford to travel - either to a place where they can get treatment or to move away from thier loved ones so that they cannot infect them.

Either way there will be many more cases like this one. Its only human.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Hello Vibrant62-

Patrick Sawyer was trying to get back to his family in the US, but didn't make it.
It was my understanding that Mr. Sawyer was on his way to an ECOWAS conference in Nigeria.

Regardless, all of this is not surprising as the mathematical models anticipated the virus emerging in other countries far afield from West Africa.

I'd like to add that I'm saddened by the tone of much discussion here and elsewhere (especially elsewhere) regarding the motives of Mr. Duncan and Mr. Sawyer.

Please consider that EVD denial is rampant in Liberia at all levels of society. Consider this and then consider what Mr. Duncan did: helped an ailing pregnant women to the hospital.

Mr. Sawyer too was in denial (insisting he had Malaria) even though he helped his ailing sister in the hospital when she was very ill with undiagnosed EVD.

All of this is completely understandable to me.

The only thing I find surprising about this case is that the apartment that Mr. Duncan was staying in has not been decontaminated and the occupants moved to a safe and clean place.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Chris,

Patrick Sawyer was headed home for his daughter's birthday, via Nigeria where the conference was held. Fortunately (for the US, anyway) he experienced symptoms before that time, but it certainly could have ended with his dying in the US instead of Nigeria.

It looks like the family in Dallas has already broken their quarantine:
http://www.wfaa.com/story/news/heal...la-patient-ordered-stay-home-dallas/16574877/

It's very strange to have to impose this kind of tactic in the US. What if they don't stay in again? Would force be used? Very disturbing, to say the least.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

I suspect that the decontamination hasn't happened because of quibbling over which jurisdiction gets that duty.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Chris: Mr Sawyer was due to head to the US for his daughters birthday after the ECOWAS conference.

Chris - I agree with you on tone of discussion; as scary as this whole thing is it is important we dont forget our compassion in all this and that we place things in context. We need to try and put ourselves in others shoes before passing judgement... but its not so easy to do when you are scared by something yourself. Fear clouds judgement.

I have been following this outbreak and its develoment since the spring and have had time to adjust, and get my head round everything. Most people here have not, so they need a little compassion too if responses seem a little terse. There is an acceptance process going on that ebola REALLY is real and that it can spread beyond Africa's shores. That is a frightening prospect.

I have confidence that FT members and posters will settle down - after all, we are all volounteers here, aimed at doing what we can to help. In the meantime, scared people may be a bit over-reactive, and may be a little out of character. They are just going through their own adjustment processes.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Force is legal in these cases but Public Health types are loathe to go there. It's interesting that TX has a judge sitting at the top of their EM response structure but, knowing TX, this is likely a good thing.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Curiosity.

I completely agree with you BUT it must be also acknowledged that fear is a very normal and human response. Rather than being papered over, fears need to be acknowledged where justified, then addressed fully and placed into context with information and transparency.

A parralel might be where an individual is told they may/do have a disease that could be fatal. There are a number of reaction processes, that are well established in the literature. I think individuals exposed to ebola probably go through the same process, as does the community around them...

A clinical psychologist can correct me, but in overview (as I understand it)

Fear and denial is the first response, usually followed by anger, followed by rationalisation, and then acceptance and resignation, and then concern for others (what will my family do if I am gone/ what if I expose them/ what if they have been exposed) and practically addressing the things that need doing to prepare for this eventuality.

People will react with fear. With something like ebola it is inevitable. What is key here is how those fears are addressed, through information, education and transparency... and time. Plenty of communication is needed about what is being done to manage the situation, minimise risks, what will be done if it has been spread to others, how they will be treated (and at whose cost), what will be done to further reduce risks of new cases escaping the system (so that any mistakes made do not happen again).

Everyone is on a learning curve and in new territory here.

Fear is absolutely normal.

Unfounded fear created by speculation and worse case scenario, non-factual information is not.

Education and information is key to reducing anxiety and resolving fear. Both of which the CDC is trying very hard to provide to the best of their ability based on how they have been trained to respond to public concern.

Everything the CDC reports continues to come under fire as not being trustworthy.

Who is the trustworthy source, then?

Who should the public look to for information and guidance? The media like CNN and FoxNews? Flutrackers?

What has the CDC said in this event that is actually false, inaccurate, or a downright lie? Where is the demonstration that they are spinning lies out of this event? Not what we "feel" is false. Not what we "think" is false. List the bona fide, factual falsities.

If I were to promote such statements about the integrity and capability of a whole system which could potentially initiate panic and fear, I would be sure:

1. to know what facts exist that demonstrate the Public Health System is failing to respond to Ebola.

2. to see factual medical studies that demonstrate the Ebola virus behaves different than what the CDC says it does

3. to document how many studies exist out there that demonstrate a person incubating Ebola is infective before they have "symptoms"

I have not seen nor do I know any of these speculative comments are fact and therefore, I choose to support the current response.

I encourage others to do the same because they need support and not doubt during this crisis.

Of course, my original point is still: The hospital missing the case the first time is not an accurate demonstration of the US Public Health response to this event.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Force is legal in these cases but Public Health types are loathe to go there. It's interesting that TX has a judge sitting at the top of their EM response structure but, knowing TX, this is likely a good thing.

Could you elaborate on this? Has force ever been used in the US, and what kind? And why is it good there is a judge because the event is occurring in Texas?

There are all sorts of interesting human behaviors that come out in epidemics. The veneer of civilization is very thin, indeed.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Chris: Mr Sawyer was due to head to the US for his daughters birthday after the ECOWAS conference.

Chris - I agree with you on tone of discussion; as scary as this whole thing is it is important we dont forget our compassion in all this and that we place things in context. We need to try and put ourselves in others shoes before passing judgement... but its not so easy to do when you are scared by something yourself. Fear clouds judgement.

I have been following this outbreak and its development since the spring and have had time to adjust, and get my head round everything.

Thanks for the extra details.

It's odd isn't it. Here two men go out of their way to show love and human compassion to another and then fate deals them and their associates this cruel blow.

EVD is, indeed, the cruelest of diseases. It just seems to strip us of our humanity. I think the NY Times piece yesterday on Sierra Leone brings the full force of that home.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Curiosity. Agreed with all points. The CDC is, and has been, leaps and bounds ahead in communications and planning and preparation - especially vs the UK, just as one example.

I wasnt trying to have a dig at anyone and not the CDC? So a little puzzled - just trying to rationalise why temperatures may be running a little high, and giving an opinion in this discussion as to what is required to address those fears, whether here on this board and/or in a larger community sense.

As for other aspects, we all (at every level) have the opportunity to learn here, and so asking questions may be no bad thing. Not everything will be perfect. Highlighting inadequacies without being emotive can help to make sure problems are addressed, and looked for. That- at the end of the day - is what will help keep people safe from infection as more introductions occur.

Many thanks for your comments - I for one greatly appreciate your inputs.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Could you elaborate on this? Has force ever been used in the US, and what kind? And why is it good there is a judge because the event is occurring in Texas?

There are all sorts of interesting human behaviors that come out in epidemics. The veneer of civilization is very thin, indeed.

If you have been a user of FluTrackers in the past year or follow public health issues within the US you would be familiar with a "recent" case in point. Guy w TB refusing to abide by local law enforcement attempts to get him to comply w quarantine. They had to take out an arrest warrant and chasee the guy over hill and dale. There are actually many such cases. Public Health authorities take TB very seriously.

Eg: http://www.ksby.com/news/arrest-warrant-issued-for-santa-barbara-tb-patient/

Here are some resources that are easily accessible via the Web

http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html

http://www.ncsl.org/research/health/state-quarantine-and-isolation-statutes.aspx
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

He said health officials are mostly concerned with people who have had prolonged exposure within three feet of a patient.

http://www.wfaa.com/story/news/healt...llas/16574877/

This is the article referenced in Dani's post.

This is droplet transmission, they need to explain that. The public could easily take it as meaning it's airborne to three feet, and that they have been lied to again.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

If you have been a user of FluTrackers in the past year or follow public health issues within the US you would be familiar with a "recent" case in point. Guy w TB refusing to abide by local law enforcement attempts to get him to comply w quarantine. They had to take out an arrest warrant and chasee the guy over hill and dale. There are actually many such cases. Public Health authorities take TB very seriously.

Eg: http://www.ksby.com/news/arrest-warrant-issued-for-santa-barbara-tb-patient/

Here are some resources that are easily accessible via the Web

http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html

http://www.ncsl.org/research/health/state-quarantine-and-isolation-statutes.aspx

Ok, thank you. I've had to dispatch law enforcement myself to bring people in for treatment, but only because no one could find them and they were suffering from a critical condition of which they were not aware, not because they didn't want to be treated. I have found law enforcement to be more than willing to help in these instances.

I was just watching Judge Clay Jenkins on TV and it seems like he has the situation well in hand. I especially appreciated the part where he advised the press that they would not be allowed to interview the people hard at work with contact tracing, etc. However, I still do not understand why it would be important to have a Judge in this position, especially in Texas. My state bears some similarities to Texas, especially the distances involved, etc.
 
Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Re: Discussion - 1st ebola case in US (excluding health care worker transfer) Dallas, Texas

Could you elaborate on this? Has force ever been used in the US, and what kind? And why is it good there is a judge because the event is occurring in Texas?

There are all sorts of interesting human behaviors that come out in epidemics. The veneer of civilization is very thin, indeed.

Hi Dani,

I work in health care, as a general statement, yes, force is used very often in healthcare where I am, and by often I mean several as in a dozen or more times per day. We have a judge available 24/7 for any paperwork we need.
 
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