Ebola and fragility

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jennypenny
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Re: Ebola and fragility

Post by jennypenny » Wed Oct 08, 2014 7:01 am

jacob wrote:I think we've just demonstrated (with one data point in each place) that both "advanced" systems are equally incompetent when it comes to diagnosis, relying on procedures rather than [not even] uncommon sense. Hopefully, these first failures will be relatively cheap "tuition".
The constant counterargument to a large ebola outbreak is our "advanced health care system." Yes, we do a better job with quarantine and a much better job with treating symptoms to avoid secondary problems. OTOH, there is currently no way to prevent or treat or inoculate against ebola. When it comes to ebola, we're not 'advanced' at all.

Chad wrote:Maybe if we changed our education system there would be more people capable of independent thought.
What we should change is "health" education. The bulk of it is sex education, which has its place, but should be taught along with healthier lifestyle choices and preventing non-STD infectious diseases since they are the biggest cause of death and disability. It's kinda sad that most kids know more about preventing herpes than they do about preventing staph infections or type II diabetes.

Despite how advanced our system is and how predictable the annual flu season is, 30-40K people still die in the US every year from complications related to influenza. That's approximately the same number of deaths as from breast cancer, yet which gets more public attention? More people die from MRSA and related staph infections than from AIDS in the US each year, but how many people are educated in preventing MRSA infections compared with preventing HIV infections?


I'm not saying we should reduce education efforts for breast cancer and HIV/AIDS prevention. I'm just pointing out that our advanced health care system is only selectively 'advanced' and health education is uneven and woefully inadequate.

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Re: Ebola and fragility

Post by Chad » Wed Oct 08, 2014 7:43 am

jennypenny wrote:
Chad wrote:Maybe if we changed our education system there would be more people capable of independent thought.
What we should change is "health" education. The bulk of it is sex education, which has its place, but should be taught along with healthier lifestyle choices and preventing non-STD infectious diseases since they are the biggest cause of death and disability. It's kinda sad that most kids know more about preventing herpes than they do about preventing staph infections or type II diabetes.

Despite how advanced our system is and how predictable the annual flu season is, 30-40K people still die in the US every year from complications related to influenza. That's approximately the same number of deaths as from breast cancer, yet which gets more public attention? More people die from MRSA and related staph infections than from AIDS in the US each year, but how many people are educated in preventing MRSA infections compared with preventing HIV infections?


I'm not saying we should reduce education efforts for breast cancer and HIV/AIDS prevention. I'm just pointing out that our advanced health care system is only selectively 'advanced' and health education is uneven and woefully inadequate.
I was talking about the doctors and nurses having the ability to think outside checklists.

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Re: Ebola and fragility

Post by jennypenny » Wed Oct 08, 2014 7:56 am

Chad wrote:I was talking about the doctors and nurses having the ability to think outside checklists.
I knew what you meant. I guess I just don't think that would help much since it only improves the situation once someone is sick. I think raising the baseline of health education would lower the overall number of people who need treatment in the first place.

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Re: Ebola and fragility

Post by Chad » Wed Oct 08, 2014 8:07 am

jennypenny wrote:
Chad wrote:I was talking about the doctors and nurses having the ability to think outside checklists.
I knew what you meant. I guess I just don't think that would help much since it only improves the situation once someone is sick. I think raising the baseline of health education would lower the overall number of people who need treatment in the first place.
I don't disagree, but I was focusing on Ebola. I wouldn't expect people in the US, Europe, Asia, etc. to know a lot about Ebola until they had too. At the beginning of something like this the medical community needs to shoulder the burden of knowledge. I agree that it should not be the same concerning the flu, staph, diabetes type II, etc., as those are very common.

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Re: Ebola and fragility

Post by jennypenny » Wed Oct 08, 2014 8:29 am

I'm not disagreeing with you either. The story about the Spanish nurse is kind of shocking.

I still think an uneducated public is key for ebola to go from an outbreak to an epidemic.
--If the public doesn't have a basic knowledge of how infections spread, educating them on how to prevent ebola is a much more daunting task.
--As prosaic said, the last place someone wants to be during any outbreak is the ER. If people took better care of their health, they could prevent most reasons for visiting an ER in the first place.

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Re: Ebola and fragility

Post by jacob » Wed Oct 08, 2014 9:27 am

The Spanish dog is more shocking. By killing it are they [rhetorically] implying that it can spread from humans to dogs, etc.? It would be hard to do canine contact tracing...

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Re: Ebola and fragility

Post by prosaic » Wed Oct 08, 2014 11:38 am

I get the checklist argument for standard medical issues, but this isn't a standard medical issue. This is a known disease with a 60-80% mortality rate in Africa that threatens to become a full blown worldwide epidemic.

The woman:

* is a nurse who recently worked with ebola patients
* goes to her doctor with symptoms that may, or may not, indicate ebola and informs the doctor of her experience with an ebola patient
* THEN the symptoms persist and she goes to an ER and informs them of her experience with an ebola patient, BUT

because she didn't meet the threshold for dx, she was sent him until she DID meet the threshold, at which point she'd potentially infected others.

Medicine by checklist just doesn't apply here. It just doesn't. She should have been observed and quarantined from the start, and she was persistent in trying to make sure she didn't spread the disease in case she did have it. Not only did the medical system fail her, each individual doctor who didn't break the "checklist" approach failed to protect public health on the whole.

When you remove critical thinking and judgment calls from the system, then why the hell have a system at all?

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Re: Ebola and fragility

Post by jennypenny » Wed Oct 08, 2014 12:02 pm

I hadn't seen the story about the dog. Seems harsh. How could they know if it could transmit between dogs and humans? They can't even figure out how she got it.

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Re: Ebola and fragility

Post by George the original one » Wed Oct 08, 2014 12:28 pm

Ebola is harbored in "bush meat", so I believe that is why the dog is suspect.

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Re: Ebola and fragility

Post by jacob » Wed Oct 08, 2014 12:31 pm

Well, it certainly can transmit from humans to dogs based on observations of dogs eating human corpses during a previous outbreak. Dogs will carry the virus asymptomatically.

Bush meat = fruit bats.

It must also be considered that this strain could be different. Previously strains have died out after 2-3 human-to-human transmissions. As for knowing more about this strain vs dogs ... well, it can't be known if the dog is killed. Kneejerk reaction.

The latest news is that the nurse might have caught the virus from touching her face with the [contaminated] glove while taking off her hazmat suit(?)

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Re: Ebola and fragility

Post by llorona » Wed Oct 08, 2014 12:37 pm

From this article on NPR: http://www.npr.org/blogs/goatsandsoda/2 ... s-his-fate
The science on whether pets can transmit Ebola to humans is unclear. The virus can infect mammals. In the current West African outbreak, the source is believed to have been an infected bat. In previous outbreaks, people may have caught the virus when they handled the carcasses of infected gorillas, chimpanzees or other non-human primates.

"There is one article in the medical literature that discusses the presence of antibodies to Ebola in dogs," CDC Director Tom Frieden said at a news conference Tuesday. The study, from 2005, looked at several dogs in Gabon who'd eaten Ebola-infected dead animals. The authors reported, "This study suggests that dogs can be infected by Ebola virus and that the putative infection is asymptomatic."

"Whether that was an accurate test and whether that was relevant, we do not know," Frieden said. But, he added: "We have not identified this as a means of transmission."

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Re: Ebola and fragility

Post by jacob » Wed Oct 08, 2014 1:26 pm


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Re: Ebola and fragility

Post by almostthere » Wed Oct 08, 2014 3:20 pm

I lived in Liberia for more than four years. Bush meat is any wild animal from bats, to small deer type animals, to largish rat type things, to monkey, etc. Some of it is quite tasty. In the countryside, people have nothing to eat, so bush meat is really the only choice. When I say nothing, I mean nothing.

@Jacob, yeah dogs, I did't think the plight of a dog or a Liberian in Africa could get any worse. Africa ahh Africa always mind-boggling to behold.

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Re: Ebola and fragility

Post by jacob » Thu Oct 09, 2014 10:14 am


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Re: Ebola and fragility

Post by jacob » Thu Oct 09, 2014 10:41 am


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Re: Ebola and fragility

Post by workathome » Thu Oct 09, 2014 10:56 am

http://time.com/3474945/politics-quaran ... ary-ebola/

Interesting that politics and ideological purity maybe more important than safeguarding lives.

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Re: Ebola and fragility

Post by jacob » Fri Oct 10, 2014 5:10 pm

It's REALLY REALLY interesting because this problem is one of those that can't be legislated or argued away unlike most consumer problems (call someone, ask for the manager, and complain). Here the 'enemy' is nature. This problem can't be argued with; just solved or not. This is a rather unusual proposition for 99% of first-worlders.

Many countries (France, Brazil, Macedonia) are popping up with "probables" suggesting that people are taking this seriously now. We also have the first "genius" making an airline joke already *rolls eyes* thus setting off the full response.

Then we have the airline cleaning personnel striking as well as Spanish hospital staff.

For sure, if this gets more serious, it's going to be used as political/economic leverage and I think more so in our "advanced" economies because we're more tightly coupled, more fragile. How long until local medical staff asks for hazard pay? Who will pay?

Flu season is on! More people coughing now eliciting frowns from their fellow potential viral hosts.

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Re: Ebola and fragility

Post by george » Fri Oct 10, 2014 5:31 pm

what can we do?
encourage our governments to send the money they need
support those amazing people who go over to help and learn

recognise that particularly our hospitals are full of super bugs etc. we have one example called the norovirus, highly contagious and dangerous for those who are already ill.
it amazes me when I see visitors visit those with superbugs, then don't clean their hands after visiting. the doctors and nurses go to huge lengths, then some people walk right past the signs, ignoring them. putting themselves and everyone else at risk.

the world is getting smaller. Ebola is just one example of the health risks. if we put the lid on all health risks, reduce the number of unwell people in the world. we all benefit. health risks become crises. Ebola is the one in the news at the moment.

and always have your civil defence supplies in the house, just in case.

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Re: Ebola and fragility

Post by workathome » Sat Oct 11, 2014 1:12 pm


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Re: Ebola and fragility

Post by Riggerjack » Sun Oct 12, 2014 8:50 am

http://www.enivd.de/EBOLA/ebola-26.htm

HOSPITAL SPREAD

From these observations. it is evident that nursing of a patient was almost a requirement for becoming infected (39 of 44 instances). Therefore, a hospital should be, and was, an ideal environment in which to transmit disease. At least one third of the staff of Maridi hospital had disease and 41 staff members died. All of the 6 medical assistants were infected and 41% of the student nurses. Before the disease was recognized, most wards of the hospital had haemorrhagic patients in them and at the height of the epidemic, the hospital was in chaos. In total, 93 of Maridi's 213 patients acquired their disease in the hospital. Most of these (72) were hospital staff infected during their duties. At least six others were patients who were infected by contact or injection with infectious material from nearby acutely ill patients. Fifteen additional people, probably received their infection as visitors of infectious patients in hospital. All of them were involved in the care of an acutely ill patient during their visit to the hospital.

SECONDARY ATTACK RATES IN THE COUNTRY

Once out of the hospital and into the community, the disease spread in a similar manner, but did not have the large substrate on which to feed that the hospital provided. We studied thirty-six families with 38 primary cases and listed contacts that resided in the same house (Table 1). As can be seen from the table, the original 38 cases had 232 contacts of whom 30 (13%) developed subsequent disease. Similar rates (14% and 9%) were observed in the subsequent generations giving an overall secondary attack rate of 12%. These results document the relatively slow rate of spread of this disease.

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