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October 02, 2014

...aaaaaand that changes the ENTIRE conversation... (tmi3rd)

Hi there, Morons and Moronettes.

As many of you are undoubtedly aware, we've had some advancements in the Ebola storyline, and it changes the perspective of the entire story.

Last night's post was based on the understanding that our dear patient in Dallas didn't know he was infected, and happened to get exposed as he was making a planned trip to visit family in the United States. That would indicate that it would be a comparatively isolated incident (around twenty people exposed and will be monitored).

That no longer appears to be the case.

More below the fold. I apologize in advance for the length of this, but there's a lot to talk about...

Okay, so here's what we know as of this evening...

Our patient's name appears to be Thomas Eric Duncan of Liberia. Check out Bryan Preston's brief rundown of the NY Times article.

He came into direct contact with a friend who had Ebola. He rode with her in a taxi and carried her from the taxi to a hospital on September 15, four days before he flew to the United States. She was turned away from the hospital because the Ebola ward was full.

She died of Ebola early the following morning. Her brother also got sick and shows Ebola symptoms. That was at the same time that Duncan started getting sick. He left Liberia and arrived in Texas on September 20. Six days later he sought treatment at Texas Presbyterian Hospital, and was sent home. He returned two days later, and has been confirmed to be infected with Ebola.

Duncan also abruptly quit his job on September 4, so he might have already planned the trip to see his family in the U.S.

But he certainly knew that he had been exposed to Ebola by the time he boarded that plane and came to Texas, four days after his friend died of it. He must surely have known it when he first visited the Texas Presbyterian Hospital, and he must have known it when the doctors sent him home.

Editorial note: it has NOT been established that he was feeling sick prior to getting on the plane, despite the above blockquote.

Let that sink in, though: he knew he'd been exposed, and it's not unfair to deduce that he thought to himself, "the Americans will save me".

We'll get back to that in a moment, as there's more fun. Via Reuters:

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.

"His whole family was screaming. He got outside and he was throwing up all over the place," resident Mesud Osmanovic, 21, said on Wednesday, describing the chaotic scene before the man was admitted to Texas Health Presbyterian Hospital on Sunday where he is in serious condition.

Now, that's not good, obviously, because you have to assume that the ground around the apartment- as well as probably the building's ventilation system- are contaminated. The good news is that bleach and Lysol can handle contaminated surfaces, and there are good professional decontamination groups who can handle those ventilation systems.

Still, that means he was (obviously) pretty sick when EMS picked him up, and that ambulance stayed in service. Now, having worked in the D/FW area, I've never known an EMS crew in the neighborhood that didn't aggressively decontaminate their ambulances daily. Certainly, one takes no chances, but the ambulance was decontaminated per CDC guidelines, and will be back in service again shortly. I don't have a problem with that.

The above link also notes that five school-age children came into contact with Duncan. That would be a nightmare scenario if the kids were already sick, but again, the bug doesn't spread until you're symptomatic. The indications are that as many as 18 people may have come into contact with Duncan while symptomatic, and they'll be monitored and kept at home for three weeks while we wait and see if they get sick.

Now, there was a mishandling of Duncan when he was initially assessed at the emergency room (this was prior to him getting his ambulance ride). He indicated to one of the staff that he was in from Liberia, but that was not communicated to the rest of the crew working on him.

I'm not going to speculate on how that happened- it's obviously a critical mistake, and it cost everyone a couple of days where they could have been getting on top of the disease. I will guarantee you that NOBODY in the business will repeat that mistake, and everyone will cross-check with each other to make sure that everyone is in the loop. Nobody in the business wants to contract a fatal disease working in the emergency room.

So, with those facts out there, let's get back to our dear Mr. Duncan, who not only jeopardized an entire continent, but set things up for an even uglier scenario down the road.

IF he survives- and he's still in pretty bad shape- then it's not much of a leap of logic to figure a lot of sick and potentially sick people will make the decision that it's worth the effort to get over to North America.

British Airways and Air France have already decided not to fly into the affected areas of west Africa, and there have been reasonable suggestions made to not admit travelers with passports from the affected areas to the United States. I actually agree with that assessment, but there's a reason it will fail mightily, and could make matters a lot worse.

Let's say the US puts a travel ban in place from western African nations. A determined person might then travel to Canada or Mexico and take their chances crossing the border there... it's a quick jump from Montreal, Vancouver, Toronto, and Winnipeg across the border into the US.

The Canadians, in my estimation, would be able to handle some of the influx, but I have no matching faith in our Mexican counterparts. Particularly along the southern border, the notion of thousands of new Ebola patients deciding to come visit fills me with no shortage of dread.

My point is that a travel ban to the US would only work if the rest of North and Central America follow suit. I don't know if that can be made to happen, and I also don't know if the folks in charge are willing to undertake something that might be construed as racially motivated.

Suffice it to say, I'm very concerned by this and angry beyond words at Mr. Duncan. What he has done endangers every last one of us, and if we as a nation can't figure out a way to keep the bug over there, our leadership has shown no capacity to handle a threat like this.

Best bet right now is to do just what you're doing- stay informed and stay healthy. It's still very unlikely any of us will see an Ebola case up close and personal (God willing), but it never hurts to make a habit of keeping your hands washed, particularly before you touch your face.

One final thing: I'm more concerned about the enterovirus, EV-68, that got loose in the Midwest. The initial set of cases caused a lot of respiratory distress, and hospitalized a lot of kids. Well, it's being linked to a rather scary paralysis as well. Now, we don't know whether it's the enterovirus itself that's doing this, or whether there's some other bug coming with it that's causing the paralysis.

The problem is that it's in the schools, and that's often where a lot of the reservoir of upper respiratory bugs come from. I'm more worried about this bug than I am about Ebola, frankly. It seems to be mainly a pediatric disease, but it's a scary one, and the timeline of when the outbreak began paints a pretty clear picture as to where it came from.

Stay vigilant and stay safe. Hopefully, this is as bad as it gets. Of course, as many have tried to tell our leadership , "hope is not a strategy".

You know where to find me if you need me. I'll answer any questions I can, within the scope of my practice and training.

Thanks for reading- have a good rest of the week.


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posted by Open Blogger at 12:06 AM

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