5 myths about Ebola

<h4><br /></h4><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr6WtjgIzeho7JQDR0wTCcWstufnq6oZeskCjXUlMJPZ5IvYzYE1dMgeY_M6ANSnVgoatdeMntCF3Y2seej3Z_STgwrGrfM9M8YYlJZ8G76TXwBo-IY97VbnTEdYY6ShZ2dGYcvyv6cqE/s1600/9c.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr6WtjgIzeho7JQDR0wTCcWstufnq6oZeskCjXUlMJPZ5IvYzYE1dMgeY_M6ANSnVgoatdeMntCF3Y2seej3Z_STgwrGrfM9M8YYlJZ8G76TXwBo-IY97VbnTEdYY6ShZ2dGYcvyv6cqE/s1600/9c.jpg" width="640" /></a></div><h4><br /></h4><h4><br /></h4><h4>1. Ebola won’t spread in rich countries.</h4><br />Until nurse Teresa Romero Ramos  contracted Ebola in Madrid, the wealthy countries of Europe, North America and Asia seemed confident that the virus could be contained in advanced medical facilities. As Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, put it after the first U.S. Ebola case was confirmed in Dallas: “We’re stopping it in its tracks in this country.” Such assurances help calm people’s nerves but may be overstated. No system of protection is 100 percent. The Spanish government has concluded that Ramos got infected as she was removing her protective suit, touching her face before disinfecting her hands.<br /><br />Like Ebola, the SARS virus spreads in hospitals, primarily through physical contact with contaminated fluids. As SARS spread across Asia in 2003, some hospitals, including in Hong Kong, had large numbers of health workers infected, while nearby facilities with similar populations of SARS patients had no employee infections.<br /><br />Hubris is the greatest danger in wealthy countries — a sort of smug assumption that advanced technologies and emergency-preparedness plans guarantee that Ebola and other germs will not spread. It was hubris that left Toronto’s top hospitals battling SARS in 2003, long after the virus was conquered in poorer Vietnam. It was hubris that led the World Health Assembly in 2013 to cut the WHO’s outbreak-response budget in favor of more programs to treat cancer and heart disease. And it is hubris that causes politicians to routinely slash public health budgets every time the microbes seem under control, only to cry out in desperation when a new epidemic appears.<br /><br /><h4>2. Post-9/11 emergency preparedness has the United States ready to fight Ebola.</h4><br />In the years after the attacks of Sept. 11, 2001, and the anthrax mailings to political and military targets, the George W. Bush administration ordered a massive overhaul of bioterrorism preparedness. From the CDC and Defense Department down to rural community clinics, doctors, nurses, hospitals and rapid-response teams went through drills imagining the arrival of pandemics or terrorist bioattacks. Routines were put in place that supposedly prepared every health department in America for the arrival of a highly contagious disease. Military and health agencies were given billions of dollars to create rapid diagnostics, vaccines and cures for highly pathogenic organisms. On every list of biological organisms of concern was Ebola. So it is reasonable to assume that billions of dollars and countless exercises later, the United States is prepared.<br /><br />But most of the training — both military and civilian — imagined the biological equivalent of an attack, in which something evil is found; responders from police, fire and health departments swoop in wearing hazmat suits; and boom: The infected people are identified, isolated and treated, and the danger to the community is gone. Even in 2005, when the White House feared that a highly virulent pandemic strain of bird flu would sweep across America, preparedness plans focused on isolating a germ and its carriers the way a bomb or chemical weapon might be isolated and defused. Missing was preparation for a long haul of contagious patient treatment, with health workers repeatedly exposed to possible contamination.<br /><br />Today, in the face of requests for help in West Africa, the answer from the U.S. Agency for International Development is: “There isn’t an existing cadre of people who have experience in treating this epidemic.”<br /><br /><h4><b>3. It could go airborne.</b></h4><br />Yes, the virus is mutating — a recent paper in Science shows that more than 300 mutations  have occurred. But what is now a virus that latches onto receptors outside endothelial cells lining the circulatory system won’t change into one that can attach to the alveolar cells of the lungs. That’s a genetic leap in the realm of science fiction.<br /><br />Viruses mutate for two reasons: random error and natural selection. Random transformation from a virus solely adapted to infect cells that line blood vessels into one that can attach to entirely different classes of proteins found in the lungs borders on the impossible. Natural selection can overcome the impossible if great pressure is put on a viral population, forcing it to alter or die out. But in Liberia, Sierra Leone and Guinea, there is no such pressure on Ebola: The virus is spreading readily and infecting thousands of people without any need to change into a radically new form.<br /><br />Far more realistic and perhaps equally worrisome is that the outer coat of the virus — the parts that are recognized by the human immune system and trigger production of antibodies and killer cells that devour viruses — might respond to immune system attack by mutating their outer proteins. If Ebola made such an adaptation, it might mean that people who have survived the disease could be reinfected, and vaccines now in the pipeline could prove ineffective.<br /><br /><h4>4. Travel bans would keep Ebola from spreading in the United States.</h4><br />The only evidence that any travel ban in the 21st century slowed down viral spread occurred right after the 9/11 attacks, when airports in the eastern United States were shut down for days, and few Americans traveled far from home for several weeks. Possibly as a result, the influenza season was delayed about two weeks in 2001. But the flu eventually came.<br /><br />Many nations have banned flights from other countries in recent years in hopes of blocking the entry of viruses, including SARS and H1N1 “swine flu.” None of the bans were effective, and the viruses gained entry to populations regardless of what radical measures governments took to keep them out.<br /><br />The days of Ellis and Angel islands screening out diseases effectively disappeared with the jet age.<br /><br /><h4>5. A vaccine is around the corner.</h4><br />There are several vaccine candidates in development right now, two of which recently got green lights from a special WHO scientific panel. That go-ahead means the potential vaccines are now being tested on human volunteers. If after a few weeks of such testing the vaccines are shown to cause no undue side effects, the next phase of trials will be carried out, probably in the epidemic countries, to see if the vaccines can protect people from the virus. If it’s obvious in that phase that the vaccine is protecting people from Ebola, the products move to the final, and most difficult, phase — a clinical trial comparing vaccine vs. placebo in hundreds of people, also in the epidemic area.<br /><br />The No. 1 question I hear privately from vaccine manufacturers regarding Ebola is: How will people dressed like space aliens in their protective gear get terrified, healthy people in Liberia or Sierra Leone to stand still for a poke in the arm?<br /><br /><blockquote class="tr_bq"><b>At best, a vaccine might be ready for final testing by spring 2015 — and that question of trust will still remain.</b></blockquote>

5 myths about Ebola

1. Ebola won’t spread in rich countries. Until nurse Teresa Romero Ramos  contracted Ebola in Madrid, the wealthy countries of Europe, North...

CDC head criticized for blaming 'protocol breach' as nurse gets Ebola

Some healthcare experts are bristling at the assertion by a top U.S. health official that a “protocol breach” caused a Dallas nurse to be infected with Ebola while caring for a dying patient, saying the case instead shows how far the nation’s hospitals are from adequately training staff to deal with the deadly virus.<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKmAZaBGVgBwXha89vPRCLUDiriVbFujxMHPMBXYRxYfDfuXy-nlUbeLzlRlcjuHNz4ZJnwRwwWftKY05etAwmK9K29A6PlSl783R_HQtvpCLAPVvakNatr_pqI-xm_dBADLnhimIZAI8/s1600/zombies2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKmAZaBGVgBwXha89vPRCLUDiriVbFujxMHPMBXYRxYfDfuXy-nlUbeLzlRlcjuHNz4ZJnwRwwWftKY05etAwmK9K29A6PlSl783R_HQtvpCLAPVvakNatr_pqI-xm_dBADLnhimIZAI8/s1600/zombies2.jpg" /></a>Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, made the declaration on Sunday at a news conference and called for an investigation into how the unidentified nurse became infected while caring for Liberian national Thomas Eric Duncan, the first Ebola patient diagnosed in the United States. Duncan died last week at Texas Health Presbyterian Hospital.<br /><br />Healthcare and infection control experts said that hospital staff need to be coached through the stages of treating an Ebola patient, making sure they have the right safety equipment and know how to use it properly to prevent infection.<br /><br />It was not immediately clear whether the Texas hospital prepared its staff with simulation drills before admitting Duncan, but a recent survey of nurses nationwide suggests few have been briefed on Ebola preparations. Officials at the hospital did not respond to requests for comment.<br /><br />Some experts also question the CDC’s assertion that any U.S. hospital should be prepared to treat an Ebola patient as the outbreak ravaging West Africa begins to spread globally. Given the level of training required to do the job safely, U.S. health authorities should consider designating a hospital in each region as the go-to facility for Ebola, they said.<br /><br />"You don't scapegoat and blame when you have a disease outbreak," said Bonnie Castillo, a registered nurse and a disaster relief expert at National Nurses United, which serves as both a union and a professional association for U.S. nurses. "We have a system failure. That is what we have to correct."   <br /><br />More than 4,000 people have died in the worst Ebola outbreak on record that began in West Africa in March.<br /><br />In recent months, the CDC has published detailed guidelines on how to handle various aspects of Ebola, from lab specimens and infectious waste to the proper use of protective equipment.<br /><br />How that information gets communicated to frontline workers, however, varies widely, Castillo said.<br /><br />In many cases, hospitals "post something on a bulletin board referring workers and nurses to the CDC guidelines. That is not how you drill and practice and become expert," she said.<br /><br />CDC spokesman Tom Skinner said the agency is still investigating the case of the Dallas nurse, but stressed that "meticulous adherence to protocols" is critical in handling Ebola. "One slight slip can result in someone becoming infected."<br /><br />Skinner said the CDC is going to step up its education and training efforts on how to triage and handle patients, and may consider designating specific hospitals in each region as an Ebola treatment facility.<br /><br />"We've been doing a lot over the past few months, but clearly there is more to do," he said. "The notion of possibly transporting patients diagnosed with Ebola to these hospitals is not something that is out of the question and is something we may look into.”<br /><br /><b>LEGAL RECOURSE</b><br /><br />Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, also disagreed with the talk of a breach of protocol, saying it just puts the onus on the nurse.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigWMfNpfa7hTX0P5u8dxkjuFTGpFi1pCAtN4u38FmIQZZJOmp_uitb4SdpTJO3E3gKMYjN_0Ph9PlwMGG0XRAPVGVESFxjuc1PKDT6hkdaOILDx9J-GztnPMhwovjxRfn5D_lyIVebY0I/s1600/cdc1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigWMfNpfa7hTX0P5u8dxkjuFTGpFi1pCAtN4u38FmIQZZJOmp_uitb4SdpTJO3E3gKMYjN_0Ph9PlwMGG0XRAPVGVESFxjuc1PKDT6hkdaOILDx9J-GztnPMhwovjxRfn5D_lyIVebY0I/s1600/cdc1.jpg" width="640" /></a></div><br />"I think that is just wrong," said Macgregor-Skinner, who helped the Nigerian government train healthcare workers when a traveler from Liberia touched off an outbreak of Ebola this past summer.<br /><br />“We haven't provided them with a national training program. We haven't provided them with the necessary experts that have actually worked in hospitals with Ebola," he added in reference to U.S. hospital staff.<br /><br />Legal experts said the Dallas nurse may be entitled to compensation if the hospital carries workers' compensation insurance. If it doesn’t, she would have the right to sue the hospital for damages under Texas law, said Jay Harvey, a lawyer in Austin, Texas.   <br /><br />Her ability to show that the hospital was negligent by, for example, not providing proper training, would be key to winning such a suit, Harvey said.<br /><br />Sean Kaufman, president of Behavioral-Based Improvement Solutions in Atlanta, helped train healthcare staff at a special isolation unit at Atlanta's Emory University which treated U.S. aid workers Dr. Kent Brantly and Nancy Writebol, the first two Ebola patients to be treated on U.S. soil.<br /><br />He would observe the nurses and doctors as they cared for patients and keep detailed notes when someone would accidentally touch their sleeve or mask with an infected glove.<br /><br />He then helped coach them through the process of carefully removing their infected gear. Facilities caring for Ebola patients are encouraged to use a buddy system so that colleagues are watching each other to make sure they don't take risks.<br /><br />"Doctors and nurses get lost in patient care. They do things that put themselves at risk because their lens is patient-driven," Kaufman said. In Dallas, "I suspect no one was watching to make sure the people who were taking care of the patients were taking care of themselves," he said.<br /><br />CDC and Texas health officials said the nurse who became infected had been wearing the recommended personal protective gear for Ebola, which consists of gloves, a gown, a mask, and a shield to protect the eyes from possible splatters from the patient.<br /><br />According to experts, that gear offers the minimum level of protection. When an Ebola patient enters the latter stages of the disease, as Duncan did, they become so-called fluid producers, Kaufman said.<br /><br />"Towards of end of the illness, the virus is trying to live and thrive. It's trying to get out of the person's body. It's producing massive amounts of fluid," he said.<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguwE5jh-R4_fPPMdisQS2QgoycSx2VETW-ipkw3uAc3X0Eiluf_VDFJbM1EQthkSMh_gikgYk51T47fZ_FtOQNL9_4VklakIubZ4Dj53Xm0FLtLYpM0LxqklRfiu2TvFoBWL_MJMKfeso/s1600/CDC.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguwE5jh-R4_fPPMdisQS2QgoycSx2VETW-ipkw3uAc3X0Eiluf_VDFJbM1EQthkSMh_gikgYk51T47fZ_FtOQNL9_4VklakIubZ4Dj53Xm0FLtLYpM0LxqklRfiu2TvFoBWL_MJMKfeso/s1600/CDC.png" /></a>At that point, caregivers need to add more layers of protective gear, such as double gloves and a respirator or a full bodysuit. Those kinds of decisions need to be made by managers who are constantly assessing the risk to healthcare workers, Kaufman said.<br /><br />Macgregor-Skinner said all U.S. hospitals must be ready to identify and isolate an Ebola patient, but should also be able to turn to a regional facility that is better prepared to receive them.<br /><br />“Every hospital can then prevent the spread of Ebola, but not every hospital in the U.S. can admit a patient in the hospital for long-term care,” he said.

CDC head criticized for blaming 'protocol breach' as nurse gets Ebola

Some healthcare experts are bristling at the assertion by a top U.S. health official that a “protocol breach” caused a Dallas nurse to be in...