Kaci HIckox: A Hero!

   My hat is off to Kaci HIckox. She volunteered to go to Africa to help fight Ebola, and thus help keep it from our shores. She then struck a blow for our own political freedoms by exposing many politicos, pundits and three Governors for the fear mongering, anti-science, vindictive bullies they are at heart.
   Chris Christie, you say you will go to"any length" to protect the citizens of New Jersey from Ebola. That is not your job, it is the job of the New Jersey State Department of Health. You and all the other medically and scientifically challenged authorities should stand down and let the qualified professionals do their job.
   Our nation has a sorry history of trampling the constitutional rights of the citizenry when fear mongering politicians and the media stoke up the worst instincts of people. The internment of Japanese-American citizens during WWII, the excesses of the McCarthy paranoia and the "Patriot Act" all come to mind. Now the threat is from "Ebolanoia".
   A story comes to mind: A man is walking down the street, snapping his fingers in rapid succession. Another man asks him "Why are you doing that?" The first man replies "To keep the Elephants away". The second man says "But there are no Elephants within thousands of miles of here!" To which the first man says "Works pretty well, doesn't it!"
   The internment of the Japanese Americans proved to be unnecessary and wrong, as did the anti- communist fervor of the early fifties. If the truth be told, the worst measures of the Patriot Act will prove just as ineffective, and just as wrong. Yet our precious freedoms and liberty have been eroded and damaged, perhaps beyond repair.
   Kudos to Kaci for a blow for rationality in the face of fear!

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Nurses and Ebola

   I am very pleased with the news that both of the nurses who contracted Ebola in Texas have made recoveries. It has become apparent that health care workers, and nurses in particular, are the individuals most at risk during outbreaks of infectious diseases such as Ebola.
   There has been  much discussion in the literature of infectious diseases concerning the course of a hypothetical large scale outbreak of Ebola here in the USA as opposed to what has actually been seen i Africa. The speculation is that the mortality rate would be a great deal lower here for several reasons:
   1. Hygiene. The limitations on the supply of clean water make a western standard of hygiene difficult, if not impossible, most places in Africa. This makes handling of patients far riskier.
   2. Nutrition. A well nourished person has an immune system far more capable of fighting off Ebola.
   3. Co-morbidities. The presence of other disease processes would make Ebola more likely to be fatal. Take for example Malaria. It is estimated that at any given time, 30 to 40% of the population in west Africa is carrying Malaria.
   4. Cultural practices in caring for family members who are ill and in dealing with the dead make the spread of Ebola more likely in west Africa than here.
   5. The supportive care (IV hydration, parenteral nutrition, etc) available to an Ebola victim here is vastly superior to west Africa. Supportive care gives the body a better chance of overcoming the virus.
   The medical people in these discussions are estimating that the mortality rate would be in the range of 20 - 30 %. Still a very scary number, but nowhere near the 40 - 60% that has been seen in Africa.
   Another concern is that many health care workers would simply not show up for work in the event of a major outbreak. The level of risk in west Africa is actually greater than in front line infantry engaged in combat. Nurses are not soldiers, and have not signed on for those sort of odds of survival.
   Food for some serious thought. It does not have to be Ebola. There have been outbreaks of influenza  with similar morbidity and mortality, the Spanish Flu that broke out just after WW1 for example.

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Nurses, Ebola, Hospitals and the CDC

  Texas Health Presbyterian Hospital (THPH) has apologized to it's community for the mishandling of the Ebola patient. Missing, however, is any apology to the nurses who work there for the chaos, incompetent management and lack of leadership that led to two nurses getting infected and more than forty confined to their homes in quarantine. Accountability? I thought that what admins are paid the $$ and why they get the perks.
   The CDC says it is revising its protocols for PPE (Personal Protective Equipment) for nurses caring for Ebola patients to include 100% coverage of skin and hair with impermeable material and the process for removing it. Not to mention how to handle the infectious waste. About time. Do the nurses get an apology from the CDC?
   How about the Lab worker from THPH that was confined to her cabin for the duration of the  vacation cruise she was on?
   The message we get is that health care workers are "little people" who do not count and are expendable, and hey, taking those kind of risk is what they get paid for, right?

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Nurses, Ebola and the CDC

How the CDC handles Ebola in it's lab:

How the CDC handles an infected Nurse's apartment:

 

How the CDC says nurses should handle Ebola:

This nurse will not care for any Ebola Patient without the same kind of gear the CDC uses for its own people.

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Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United | National Nurses United

Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United | National Nurses United

Ebola, Nurses and Hospitals

 The reports coming out of the Hospital in Texas from nurses are truly alarming. A picture of a failure of leadership, decisions on protocol being made by clueless administrators which changed on a day by day basis. Apparently, the patient was treated using standard "Contact Isolation" procedures which are totally inadequate for a disease like Ebola. Below is a protocol for Ebola sent E-Mail to the nurses of a highly respected hospital with a national reputation for excellence.

 First, contrast these pictures with what you have seen on TV of health workers in Africa in full hazmat suits being sprayed down with disinfectant after coming out of contact with patients before disrobing. Second, the panel on the sequence for removing protective equipment has a serious error: Instructing one to remove gloves first. Right. Then you touch your contaminated gown etc. with bare hands. Any OR nurse will tell you that you remove your gloves LAST.  Note also the lack of Hoods to cover head and neck, backless gowns, lack of rubber boots or clogs that can be autoclaved (high temperature/pressure sterilization), or any information on how to deal with all the contaminated trash, how to deal with floors and bedding contaminated with all manner of body fluids, etc. They handle all of this better in the bush in Africa.
  If this was how they were dealing with Ebola in Texas, it is a miracle that only two nurses contracted the disease. It is also apparent that nurses were assigned to go straight from the Ebola patients room to care for other patients.
  It is also apparent that nurses are reluctant to speak up for fear of retaliation.
  Lastly, read Richard Preston's book "The Hot Zone" to see how NIH (not CDC) deals with Ebola. That will really open your eyes as to the inadequacy of the above protocols. If either of these nurses dies, the authorities of that Texas hospital should be tried for murder or at least manslaughter.

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A new blog:

Orfyn has started a new blog, another book in progress. Please visit www.carrstale.blogspot.com

While you are here, scroll down or jump to July 2012 and read A sample of the book "The End of Shift Report"Thank You!