[Health] The Infectious Diseases Thread

[Smoove_B]

Ahh...now that's what I would have expected -- and here I thought they did the right thing initially. I didn't want to jump to conclusions that they screwed up, but good grief. Thanks for sharing that - it's a perfect example of people knowing what they should be doing versus what they actually do. Terrible.

[Ralph-Wiggum]

How do the early symptoms of Ebola differ from some more common diseases?

[LawBeefaroni]

Even from watching Scrubs, I know that getting a full and complete history is important. They treated and streeted him, and it wasn't until he came back two days later that he was sick enough that they finally caught it.

Electronic medical records often force providers to ask all the right questions but in some ER settings, depending on what's going on, things can get missed. If they're on paper charts, that likelihood goes up even higher.

A guy who walks into an ER for what he thinks the flu (or whatever) is probably not a very compliant patient to begin with. Even if he's not thinking Ebola, the fact that he's visiting from Liberia should be one of the first things he tells ER staff. Do we even know where he's originally from? Does he speak English? I know it's the official language in Liberia but he may not be from there. We just know that his flight originated there.

It's a lapse for sure, but without more detail it's hard to put all the blame on someone willfully failing to take a history.

[Isgrimnur]

Stupid HIPAA.

[Smoove_B]

How do the early symptoms of Ebola differ from some more common diseases?

They don't. But considering the CDC issued advisories last month to make sure that doctors, hospitals, etc... are all asking people with those early, non-specific symptoms if they've traveled in the last 21 days, or been around people that had been traveling, it's a HUGE oversight on their part.

Some random person walking into a clinic with Ebola...they're going to slip through. But after there's a epidemic raging on the other side of the globe? No excuse.

[Blackhawk]

I don't blame the patient for not telling them. Your recent travel isn't a thing that everybody out there knows is relevant. The incubation period is long enough (how long had he been back?) that he may not have connected it. Even if he would normally be aware of such things, standing in an ER with a massive fever doesn't make for the clearest thinking.

[Isgrimnur]

EV-D86 co-morbid death:

A Rhode Island child hospitalized with Enterovirus D68 has died of a bacterial infection in what state public health officials described on Wednesday as an unusual and dangerous combination.

The child, a 10-year-old girl who was not named, died last week as a result of a staphylococcus aureus sepsis alongside the respiratory virus, the Rhode Island Department of Health said in a statement, calling it a "very rare combination that can cause very severe illness in children and adults."

She had been hospitalized for less than 24 hours when she died, and doctors do not know how or when she acquired the bacterial infection, said Christina Batastini, a spokeswoman for the state health department.
...
Officials were careful to remind the public that very few people who contract the Enterovirus D68 will develop symptoms beyond a runny nose and low fever.

"Many of us will have EV-D68. Most of us will have very mild symptoms and all but very few will recover quickly and completely," said Michael Fine, director of the state Department of Health, in a statement.
...
The EV-D68 virus has been confirmed in 472 people, mostly children, in 41 states plus the District of Columbia, according to the U.S. Centers for Disease Control and Prevention.

EV D68 is one of more than 100 non-polio enteroviruses, a group of viruses that are common at this time of year and cause 10 million to 15 million infections in the United States annually.

[PLW]

Why do people get all upset about Enterovirus? The seasonal flu seems worse.

[Isgrimnur]

Perry: US Ebola Patient Exposed School Age Children

The children had contact with the patient and are being monitored at home, Texas Gov. Rick Perry said today in a press conference.

[Isgrimnur]

Patient told Dallas hospital he was from Liberia

The first Ebola patient diagnosed in the United States told health care workers on his initial hospital visit that he had recently been in an area affected by the deadly disease, but that information was not widely shared, a hospital official said Wednesday.

Thomas Eric Duncan went to a Dallas emergency room Friday and explained that he was visiting the U.S. from Liberia. He was sent home with antibiotics, according to his sister, Mai Wureh.

So much for HIPAA.

[Jeff V]

Perry: US Ebola Patient Exposed School Age Children

The children had contact with the patient and are being monitored at home, Texas Gov. Rick Perry said today in a press conference.

If only Texas had a department of education, healthcare workers in the state might know where Liberia is.

[Isgrimnur]

Contact history

Mr. Duncan, the first person to develop symptoms outside Africa during the current epidemic, had direct contact with a woman stricken by Ebola on Sept. 15, just four days before he left Liberia for the United States, the woman’s parents and Mr. Duncan’s neighbors said.

In a pattern often seen here in Monrovia, the Liberian capital, the family of the woman, Marthalene Williams, 19, took her by taxi to a hospital with Mr. Duncan’s help on Sept. 15 after failing to get an ambulance, said her parents, Emmanuel and Amie Williams. She was convulsing and seven months pregnant, they said.

Turned away from a hospital for lack of space in its Ebola treatment ward, the family said it took Ms. Williams back home in the evening, and that she died hours later, around 3 a.m.

Mr. Duncan, who was a family friend and also a tenant in a house owned by the Williams family, rode in the taxi in the front passenger seat while Ms. Williams, her father and her brother, Sonny Boy, shared the back seat, her parents said. Mr. Duncan then helped carry Ms. Williams, who was no longer able to walk, back to the family home that evening, neighbors said.
...
Sonny Boy, 21, also started getting sick about a week ago, his family said, around the same time that Mr. Duncan first started showing symptoms.

In a sign of how furiously the disease can spread, an ambulance had come to their house on Wednesday to pick up Sonny Boy. Another ambulance picked up a woman and her daughter from the same area, and a team of body collectors came to retrieve the body of yet another woman — all four appeared to have been infected in a chain reaction started by Marthalene Williams.

A few minutes after the ambulance left, the parents got a call telling them that Sonny Boy had died on the way to the hospital.

[WYBaugh]

Contact history

Mr. Duncan, the first person to develop symptoms outside Africa during the current epidemic, had direct contact with a woman stricken by Ebola on Sept. 15, just four days before he left Liberia for the United States, the woman’s parents and Mr. Duncan’s neighbors said.

In a pattern often seen here in Monrovia, the Liberian capital, the family of the woman, Marthalene Williams, 19, took her by taxi to a hospital with Mr. Duncan’s help on Sept. 15 after failing to get an ambulance, said her parents, Emmanuel and Amie Williams. She was convulsing and seven months pregnant, they said.

Turned away from a hospital for lack of space in its Ebola treatment ward, the family said it took Ms. Williams back home in the evening, and that she died hours later, around 3 a.m.

Mr. Duncan, who was a family friend and also a tenant in a house owned by the Williams family, rode in the taxi in the front passenger seat while Ms. Williams, her father and her brother, Sonny Boy, shared the back seat, her parents said. Mr. Duncan then helped carry Ms. Williams, who was no longer able to walk, back to the family home that evening, neighbors said.
...
Sonny Boy, 21, also started getting sick about a week ago, his family said, around the same time that Mr. Duncan first started showing symptoms.

In a sign of how furiously the disease can spread, an ambulance had come to their house on Wednesday to pick up Sonny Boy. Another ambulance picked up a woman and her daughter from the same area, and a team of body collectors came to retrieve the body of yet another woman — all four appeared to have been infected in a chain reaction started by Marthalene Williams.

A few minutes after the ambulance left, the parents got a call telling them that Sonny Boy had died on the way to the hospital.

And patient zero couldn't possibly think that he maybe, possibly had Ebola?

So you go into a hospital, sit around in the ER, infect how many(?), leave, continue infecting, then come back once again? Wow.

[WYBaugh]

And this is his first visit to the US. Thanks dude.

[Smoove_B]

Why do people get all upset about Enterovirus? The seasonal flu seems worse.

It is...but it's something new and the fact that it's relatively rare and suddenly spreading rapidly across the U.S. is something to raise an eyebrow over. The fact that it's causing severe complications in children with existing respiratory ailments (like asthma) is also upping the fear factor. There's also been the question as to whether or not it's causing paralysis in some children, like its cousin Polio. That has potential to change everything as our generation hasn't dealt with outbreaks causing permanent damage for decades - and part of the reason why some parents today are so anti-vaccination. The collective memory of chronic impacts for diseases like mumps, polio and the measles is getting smaller and smaller.

[Isgrimnur]

Pity the vomit moppers:

Two days after he was sent home from a Dallas hospital, the man who is the first person to be diagnosed with Ebola in the United States was seen vomiting on the ground outside an apartment complex as he was bundled into an ambulance.
...
Texas health officials said that up to 18 people, including five children, had contact with the Ebola patient after he traveled to the United States from Liberia in late September. The children had gone to school early this week but have since been sent home and are being monitored for symptoms.

[Isgrimnur]

Feeling under the weather?

[Ralph-Wiggum]

Possible Ebola patient in Hawaii. Run for the hills!

[Isgrimnur]

Let's expand the monitoring a level to 80.

The Dallas County Health and Human Services agency said that the list of individuals being interviewed and monitored for possible Ebola symptoms has grown from more than a dozen to around 80. The expansion comes as officials try to assess how far exposure to the disease may have rippled since a Liberian man, Thomas Eric Duncan, was diagnosed with the disease on Tuesday.

The list of about 80 includes people who had direct contact with Mr. Duncan, as well as individuals who subsequently had contact with those people, said Erikka Neroes, a spokeswoman for Dallas County Health and Human Services.

[coopasonic]

Just how many people did that guy share fluids with?

[Blackhawk]

There is almost zero chance that the contacts-of-contacts could contract it, as none of the first tier contacts have been reported as showing symptoms. They're just being paranoid-careful because of the consequences of this cat leaving its bag.

[Smoove_B]

Just how many people did that guy share fluids with?

Don't confuse the labels. There's about 18 people he had direct contact with and another 62 they identified as people he was in casual contact with. Perhaps people he was on a bus or elevator with them. Those 62 some-odd people need to risk-assessed and then set aside. Oh, and the article said they're expanding the circle to contacts of contacts, so the number balloons even more.

It also goes to show you just how many people you interact with over the course of a few days without even realizing it.

EDIT: It's up to 100, by the way.

[Fretmute]

I just read my first Facebook post suggesting that I should not believe the government's lies about Ebola, and that essential oils and colloidal silver are my best defense.

[noxiousdog]

I just read my first Facebook post suggesting that I should not believe the government's lies about Ebola, and that essential oils and colloidal silver are my best defense.

Duh.

[Isgrimnur]

What's a little argyria among friends?

[Smoove_B]

I just read my first Facebook post suggesting that I should not believe the government's lies about Ebola, and that essential oils and colloidal silver are my best defense.

Just watch yourself with the colloidal sliver. I'd probably avoid making your own.

While I don't think that Ebola outbreaks will be an issue here in the United States, I am getting a bit concerned over what will happen if we have one or two more people test positive in various locations. Again, not because I think there will be waves of people with the disease or something crazy, but the amount of work that goes into running down a single case and the contacts is above and beyond our what I've seen in terms of capacity (manpower) to deal with this stuff. The system works great when we can descend on Texas and pour all of our attention into one event, but if this exact scenario unfolds in Boston, L.A, Miami, and Omaha...trouble.

[Blackhawk]

Well, it will make for a good test of the system if nothing else - and a public scare like this can help make the case for budget increases.

[Smoove_B]

Well, it will make for a good test of the system if nothing else - and a public scare like this can help make the case for budget increases.

Funny you should mention that. I finished reading a book a few weeks ago that covered (in part) the public health response to the Anthrax attacks waaaaaaaay back in 2001. As suggested, there was a ridiculous influx of money that was injected into public health infrastructure from the feds but it was horribly mismanaged and overall the preparedness levels did not universally improve nationwide. I was the recipient of training and education directly related to those funds provided, so reading about the cluster-f associated with how the money was spent nationally was quite an eye-opener.

The issue here is that he federal government isn't a first responder. Now that we're seeing that the Dallas hospital system apparently had communication failures, the pressure is on the County, City? (?) health department to step up and somehow reign this in. Of course, they're getting help from the feds but everything builds on the preparedness level found in Dallas overall - and that's the problem. Not ever state or city has the same level to start. So if a patient shows up in the wrong place and the early warning systems fail again, unless the locals have a strong and immediate response it will quickly spiral out of control. The feds can help, but they can't in any way replace or mitigate failures on a state or county level - and that's by design.

[Isgrimnur]

And then the graboids take out the only road into town, and it's all over.

[Smoove_B]

Ugh, seeing reports that the patient's status is deteriorating. If he dies, people are going to become unhinged.

[coopasonic]

Isn't that kind of the expected outcome of ebola?

[Smoove_B]

Traditionally, yes based on where the outbreaks were occurring. But for medical care here in the United States the assumption was the survivability was higher. Of course, had he been treated last week when he started showing symptoms that might have been another story altogether.

[Trent Steel]

Ugh, seeing reports that the patient's status is deteriorating. If he dies...

[Alefroth]

I just read my first Facebook post suggesting that I should not believe the government's lies about Ebola, and that essential oils and colloidal silver are my best defense.

Just watch yourself with the colloidal sliver. I'd probably avoid making your own.

.
Ah Blue Man. He lived right around the corner from where I work and I'd see him on a regular basis. He even posed for pictures with some vendors we had on site from Philly.

[stessier]

Ugh, seeing reports that the patient's status is deteriorating. If he dies, people are going to become unhinged.

Isn't the survival rate around 50% in Africa right now? Most people who work with me think it is much lower - and that's without our health care system. No one thought he was going to make it. There are also some people going into full survival mode (which tends to amuse me).

[Smoove_B]

Isn't the survival rate around 50% in Africa right now? Most people who work with me think it is much lower - and that's without our health care system. No one thought he was going to make it. There are also some people going into full survival mode (which tends to amuse me).

I work in terms of case fatality rates and historically, it's been around 80-90%. However, if you look at the number of people with Ebola in 2014, it's now more than everyone that we ever knew with Ebola from 1976-2013, so calculating the case fatality rate is getting muddy.

This article explains it a bit better:

Because different outbreaks of the same disease can demonstrate different CFRs, there’s usually a range of possible CFRs for a given disease. In the past, outbreaks caused by Zaire ebolavirus have demonstrated a mean end-of-outbreak CFR of 80% [1]... But based off of the WHO's most recent report, it seems that only about 53% of reported Ebola cases thus far have ended in death since the 2014 outbreak began.

However, if we want to be particular, that 53% isn't really a CFR; it's actually the proportion of fatal cases - or PFC. This is a critical distinction. Because the outbreak in West Africa is still ongoing, we can't calculate end-of-outbreak CFR yet. We don’t know how many people will die from Ebola in the weeks ahead or how many total cases will ultimately accumulate by the end of the outbreak. So, for the time being, we have to make do with the PFC, which is essentially the number of deaths thus far divided by the number of cases to date.

So essentially, we can't really calculate the true CFR yet until the outbreak ends - we can only take a snapshot of how things look at any given time.

[Ralph-Wiggum]

I know it's probably hard to pinpoint, but any idea of the transmission rate of Ebola? Does coming into contact with fluids (let's say for example kissing) guarantee transmittance?

[Smoove_B]

I don't think we know. From what I understand the greatest chance of transmission occurs as the person is dying and/or right after death. Apparently that's when body fluids have the greatest viral load - and why the burial practices in certain parts of Africa (ritual washing of corpse) were problematic. I have no idea if we've ever quantified infectious dose outside of an ideal laboratory setting.

I was surprised to learn (from the book I was reading about Anthrax) that the models used to guess infectious dose were from the 50s and 60s -- suggesting 10K or 20K spores were needed to make people sick via the airborne route. Now? We think under the right conditions it might be less than 10 based on the data associated with the attacks. The books are being re-written on Ebola as we speak.

[Kraken]

Ugh, seeing reports that the patient's status is deteriorating. If he dies, people are going to become unhinged.

Isn't the survival rate around 50% in Africa right now? Most people who work with me think it is much lower - and that's without our health care system. No one thought he was going to make it. There are also some people going into full survival mode (which tends to amuse me).

My news feed seems to be working itself into a lather. Haven't read any of the stories; I trust only Smoove.

[Fretmute]

Ugh, seeing reports that the patient's status is deteriorating. If he dies, people are going to become unhinged.

It gets better!

One of five Dallas ISD students who had contact with Ebola patient went to school Wednesday.