The Barbados government has established an Ebola isolation centre on an adjacent compound to the Queen Elizabeth Hospital overlooking two popular schools. This week we learned about health care workers who have become infected with Ebola after treating Ebola patients and the reason given by the … National Nurses United, the largest registered nurse union, surveys of their membership indicate that most nurses feel hospital administrations have not communicated adequately with staff about Ebola response plans – Ebola Protocol Breach Raises Questions About Where to Treat Patients
The latest development is important because if health workers like those in Jamaica threaten not to treat Ebola patients, we have a problem. The following two comments by BU family members are important to the Ebola conversation.
Two Comments by are-we-there-yet extracted from the EBOLA Virus Enters the White Man’s World #2 blog
Miller; You’ve brought up just one good point in your post above. That is “the issue of the need for people dealing with the Ebola virus to be outfitted in spacesuits as if the infection has been brought in by aliens from another world?”
Yes! It would appear to be absolutely necessary that caregivers at all phases of the development of the disease in a potential ebola stricken patient must be outfitted in adequate fool proof Personal Protective Equipment (PPE) and that they be totally trained in how to put on, take off and use that equipment. Failure to secure PPE’s of the absolutely highest standards and to use them properly appears to be an absolute death sentence.
The case histories of the persons who have contracted ebola all suggest that the disease is very infective and that absolutely strictly observed guidelines must be followed and enforced in robing, using and disrobing from those PPEs. Two of the cases of spread outside Africa so far appear to have been due to improper disrobing from the PPE’s.
If, heaven forfend, the disease gets into Barbados we will have a number of challenges re. the use of PPEs. One challenge will be getting workers to use the PPE’s in our sweltering heat. I expect that even if light weight PPE’s are used there might be a trade off between the procurement of heavy weight effective suits and lightweight (also claimed and even proven to be effective) suits that are more likely to be used sensibly by the caregivers.
Spain and the USA would not have had any such problem.
Back in Liberia, 10 of the people who assisted in getting the sick pregnant woman to the hospital there with Duncan have already died and it is likely that that is not the end of spread from that source of the virus. The video of the enclave that Duncan lived in suggests that those people in the compound wear no protective clothing whatever and that the Government workers are doing their best (also without wearing your spacesuits) to identify all contacts and move them out to quarantine areas. The conditions do not appear the best for containment of further spread.
The short history of the spread of this outbreak, its ability to infect workers in the US and Spain who are fully protected by PPE’s and its galloping spread in the infected countries in West Africa suggests to me, FWLIT, that the authorities have got it a bit wrong re. the method of spread and the infectivity of the virus. If they continue to publish the information that they are currently providing many more will die.
In the meantime, I think tightening up on the protocols for use of the PPE’s and allowing for the possibility of its spread through the air and by inactive carriers such as mammalian pets who might inadvertently transmit infective material from one human host to another, could reduce the spread potential and thereby limit the movement of the disease from where it currently has taken hold.
Note that there is no outbreak in the US or Spain. It has not reached that stage yet and we should all pray that the authorities there can contain it.
Why do you think Obama is sending so many troops into harms way. He and his advisors realises that they have no choice. I hope he is successful.
#2 comment
There are some very interesting questions raised by today’s developments in the Ebola story. viz; One or more caregivers of Ebola infected patients have contracted the Disease in the USA and Spain. There is possibly another carrier of the disease from Liberia to another part of the USA. None of the persons closest to Duncan and who were in unprotected close contact with him when he first started showing symptoms have yet shown any signs or symptoms of the disease while 2 presumably well protected professionals have come down with the disease. The Health workers around the US have been protesting that they have not been advised of the protocols which CDC says that hospitals are operating under while being blamed for not strictly adhering to those protocols. The system in the US and Europe seems rather chaotic at this time.
The questions are?
Are the US health services or indeed any country’s health services really ready for the complicated task of containing and controlling this outbreak?
Are the Health workers who might come in contact with carriers of the disease being told the full story of the epidemiology of this strain of the virus?
What does this portend for Caribbean health services in general and Barbados in particular?
Why should the virus either take longer to develop or doesn’t develop at all in unprotected black persons who were in intimate contact with Duncan at an eminently infective stage of his illness while some professional well protected caregivers and presumably white have contracted it? Is there a genetic difference? Could wearing the PPE’s be actually providing a better chance for the the virus to infect persons than if they were not worn at all? Should there be some trials done on identifying the best wear for eliminating transmission of the virus?
Was there a distinct difference in the care in the US of Duncan as compared with that of the others who had contracted the virus and been treated using experimental medicines. If there is a difference could that explain to some reasonable extent why Duncan died and the others have survived?
Should Barbados and the Caribbean seek to have some of its IT professionals in collaboration with our health professionals, work out and develop a total epidemiological package for Ebola that would allow us to manage Ebola better when it gets here?
Comment by Sargeant extracted from the EBOLA Virus Enters the White Man’s World #2 blog
@David
What is happening with these health workers contracting Ebola? A worker who nursed Duncan affected
+++++++++++
They are overlooking basic precautions, wearing the Hazmat suit is not enough, you have to be careful when removing it also, the exterior has to be disinfected prior to removal less any of the virus is present on it. Like going to a public washroom and washing your hands but opening the door with your bare hands which is a no-no. One should always try to avoid public washrooms but if you must go grab a paper towel to hold onto that door handle on your way out.
173 responses to “ebola, EBOLA”
Lawson; You have a very good point in your 12:16 pm post.
They should have suspected that Duncan might have been infected with Ebola by the time that they took him to the Hospital the first time. But, call it laughable stupidity or whatever, their never actually mentioning the word Ebola might not necessarily have been deception but could have been some sort of mental shamanic defence mechanism hoping that the unthinkable would turn out not to be so and the Hospital, by sending him back home after that examination, might have been reassuring to them that it might have been something else. However, by the second hospital visit they would have been almost certain that he had indeed contracted Ebola but they could not just abandon him and they provided the support that their traditions required of them at that time.
Unless they disclose everything that happened between them and Duncan throughout his visit, it will remain speculation. In my view, for now, these were just simple folk, who were in the wrong place at the wrong time.
Too bad that the most likely outcome is that one or more of them will contract the disease. If they don’t and they remain free from it, CDC should buy their secret for remaining uninfected and patent it.
Also with the rollout of the revamped CDC checklist the triadging would have come part of a retraining exercise, or should have been.
DONKEY SAID
it is highly unlikely that a hospital in America would admit a patient like Mr. Duncan with a mere temperature,
DONKEY HAS NEVER HEARD OF THE DIAGNOSIS PYREXIA OF UNKNOWN ORIGIN! THIS IS A CAUSE FOR ADMISSION
GP If I had Father Damian visiting me from Molokai and one of his fingers fell off at the dinner table rest assured when we went to the hospital Hansen disease would be mentioned …not he is visiting me from Hawaii. This tale is bizarre to say the least
LAWSON
I THINK YOU SHOULD TRIAD Father Damian sIR LOL
are-we-there-yet | October 13, 2014 at 12:47 PM |
Lawson; You have a very good point in your 12:16 pm post.
They should have suspected that Duncan might have been infected with Ebola by the time that they took him to the Hospital the first time.
YOU ARE 100% CORRECT SIR
NOT ONLY WAS THIS POOR HISTORY TAKING BUT POOR “TRIAD-ING”
GP the disease is triading him naturally instead of with a cleaver
We have alread established that the hospital which treated Duncan had some major problems in the past. So that’s a no brainer sir.
Ottawa admitted someone with ebola like symptoms yesterday ….. they had visited Africa recently, how long before the bell tolls for thee
We talk about leadership on BU ad infinitum ad nauseamque but when we ought to be leading by example, we continue to type shit on the blog.
WITH RESPECT TO THE USE OF THE WORD “TRIAD” AS USED IN MEDICINE
A triad is a group of three signs or symptoms used to diagnose a disease. IT HAS NOTHING IN THIS WORLD OR THE NEXT TO DO WITH SORTING OUT PATIENTS IN AN ER
Here are a few examples of TRIADS
Charcot’s triads
There are two sets of Charcot’s triads relating to quite separate diseases.
A. Charcot’s triad for multiple sclerosis
1. Nystagmus
2. Intention tremor
3. Scanning or staccato speech
While this triad is characteristic of multiple sclerosis, it is not considered definitely diagnostic.
B. Charcot’s triad for ascending cholangitis
1. Jaundice
2. Fever, usually with rigors
3. Right upper quadrant abdominal pain.
Charcot’s triad for ascending cholangitis is a result of ascending cholangitis (an infection of the bile duct usually caused by bacteria ascending from its junction with the duodenum). When the patient presents also with hypotension and mental status changes, it is known as Reynolds’ pentad
Charcot’s triads are named for the French neurologist who first described these combinations of signs in relation to these diseases, Jean-Martin Charcot (1825-1893.
Beck’s triad
Beck’s triad was described by the thoracic surgeon Calude S. Beck in 1935. It’s components are:
1. Distended neck veins
2. Distant heart sounds
3. Hypotension
i.e. rising venous pressure, falling arterial pressure, and decreased heart sounds found in the presence of pericardial tamponade.
Cushing’s triad
Cushing’s triad (not to be confused with the Cushing reflex) is a sign of increased intracranial pressure. It is the triad of:
1. Hypertension (progressively increasing systolic blood pressure)
2. Bradycardia
3. Widening pulse pressure (an increase in the difference between systolic and diastolic pressure over time)
Cushing’s triad suggests a cerebral hemorrhage in the setting of trauma or an space occupying lesion (e.g. brain tumor) that is growing and a possible impending fatal herniation of the brain. Cushing’s triad is named after an American neurosurgeon Harvey Williams Cushing (1869-1939).
Virchow’s triad
Virchow’s triad presents the three broad categories of factors that are thought to contribute to thrombosis.
The triad consists of:
1. Alterations in normal blood flow
2. Injuries to the vascular endothelium
3. Alterations in the constitution of blood (hypercoagulability)
Alteration in blood flow can include turbulence, stasis, mitral stenosis, and varicose veins. Injuries to the vascular endothelium can be cause by damage to the veins arising from shear stress or hypertension.
Hypercoagubility can be a consequence of numerous possible risk factors such as hyperviscosity, deficiency of antithrombin III, nephrotic syndrome, changes after severe trauma or burn, disseminated cancer, late pregnancy and delivery, race, age, smoking, and obesity.
Virchow’s triad was first formulated by the German physician Rudolf Virchow (1821-1902) in 1856.
I sincerely hope that this post will prove to be EDIFYING and ENLIGHTENING
THERE IS A DISTINCT DIFFERENCE BETWEEN TRIAD AND TRIAGE
lawson | October 13, 2014 at 1:06 PM |
GP the disease is triading him naturally instead of with a cleaver
ARE YOU SAYING THAT THE DISEASE CUT HIM IN THREE? LOL
lawson | October 13, 2014 at 1:27 PM |
Ottawa admitted someone with ebola like symptoms yesterday ….. they had visited Africa recently, how long before the bell tolls for thee
SEEMS THAT SOME ONE TOOK A PROPER HISTORY THERE AND THAT THERE WAS EFFECTIVE TRIAGE
No I was saying like a Chinese triad they chop off your fingers for mistakes
The problem I have is how he or she got to the hospital because of our cities tiered response …police ..fire…ambulance may all come in contact with the individual before they make it to the hospital and I do not believe we are up to speed as we were for sars.
lawson | October 13, 2014 at 1:53 PM |
No I was saying like a Chinese triad they chop off your fingers for mistakes
WE SHOULD DO THAT HERE ON BU…LOL
“Are the US health services or indeed any country’s health services really ready for the complicated task of containing and controlling this outbreak?”
This is a very important question. I was reading the October 9, 2014 edition of “Caribbean 360: News around the Caribbean”, and the US military is also scared about the effects of the Ebola virus in Central America nd the Caribbean, but from a different perspective.
Head of the US Southern Military Command (Southcom), Marine General John F. Kelly, suggested that a an outbreak of Ebola in this region would
“trigger a mass migration to the United States”, since established Central American human traffickers could bring infected illegal immigrants to the US.
This caused me to think about those persons from the Dominican Republic and Guyana coming to Barbados to engage in “social services”. These women are in the clubs looking good, and after a few drinks they seem to look better. Then as the night progresses (along with the drinks) all reason goes through the window, and soon the only thing on that man’s mind is sex.
Georgie Porgie
Perhaps, you’re correct and I do understand that a high temperature is an indication that something is going on with the body. And general the ER doctor usually runs the blood and urine work/labs to determine the etiologies.. But admission in America as I understand it to mean, is to move from the ER to an assigned room.
RE And general the ER doctor usually runs the blood and urine work/labs to determine the etiologies..
YES I KNOW THAT IN THE USA THE TENDENCY IS TO TREAT LAB RESULTS RATHER THAN PATIENTS
Ebola “Triad Testing” involves asking the patient if they have been in one of the following 3 countries where the virus spread (Triad: Guinea, Sierra Leone and Liberia).
Over his head
Unfortunately the patient didn’t know the medical jargon and replied he was not Chinese Mafia
Space Age
http://youtu.be/JfHPIKYZnwQ
Ebola is to kill black people , white man gets Ebola and lived , white woman get Ebola and lived, black man get Ebola and dies, it seems the plan is working very well by whites and the CDC master plan.Clear the land of Africa so the whites can take it,
@Artax
Wasn’t there a reported case of Ebola in Brazil recently? It is not unusual for Guyanese to drive over the border. The conclusion we can make is obvious.
It will be interesting to read at which stage the health care worker is given an experimental drug. We know for Duncan is was given at a late stage.
Yes you are right David the hospital did nothing for this man and purposely withheld an experimental drug (the same one they gave to the nbc reporter) so they could get rid of him John Hanson may not be far off the mark now that America has a taste for monkey ass and bat instead of beef or chicken of course we would do anything to own it.
@ John Hanson
Don’t you buy into the Fruit Bat theory?
Ebola was isolated and patented in a Lab
Ebola Virus US Govt Patent #CA2741523A1
http://www.google.com/patents/CA2741523A1
There was a rumour that vaccine does not work on Black people due to melanin (which was denied)
John Hanson
John, do realize that you’re confabulating on a social blog and it is rather ignorant to advanced such a perspective without the supporting evidence. I would agree with view that the hospital could have and should have done more for Mr. Duncan, but I cannot see how this hospital deplorable actions constitutes part of a large conspiracy to destroy the African race? You sounds rather ridiculous to buying into this kind of petty thinking. Nonetheless, my general disagree with the hospital centers around the fact that its waited 6 days to administered the new viral drug to Mr. Duncan.
Where do the drains run to from the planned isolation unit?
As I am sure everyone knows, the normal (filthy) practice in Barbados is to simply pipe all the waste from a building into pits in the ground. From there, it filters through the coral stone and is eventually pumped back out to use as drinking water. Obviously, chlorination is meant to kill off all the diseases but I for one, would like some reassurance that any ebola waste is not going to end up in the drinking water supply.
St George’s Dragon;
I would expect that the first thing they would do is ensure, through their protocols, that hazardous wastes from possible ebola patients could not enter the acquifer, but I’ve been known to have been wrong before.
Perhaps what they should do is publish the protocols on the design and mandated operations of the Ebola quarantine station. But I suspect that will not be for a variety of reasons.
Georgie Porgie
I have a question for you Porgie: I have worked with patients with Methicillin Resistant Straph Aureus (MRSA), Hapitis C, AIDS, and HIV; all of which are caused by bodily fluid/liquid exposure. Now, the CDC has informed the general public that Ebola is caused by bodily fluid/liquid exposure, but with the use of Universal Precautions you can reduce your chances of exposure signifantly. So why is it that the healthcare professionals who ought to be will aware of Universal Precautions are contracting Ebola. I HAVE ARGUED HERE THAT THE INPROPER USE OF UNIVERSAL PRECAUTIONS IS THE FUNDAMENTAL REASON FOR THE INFECTED HEALTHCARE PROFESSIONALS, WHO ARE WORKING WITH EBOLA PATIENTS. Now, it was just reported by the CDC a few minutes ago that the nurse who was infected by Mr.Duncan, gave several inconsistances in the way in which she put on and took off her protective uniform. Which confirms my belief that the lack of proper Universal Precautions is at the root of this exposure.
GP
knowing all that has said about the virus at present would you treat an Ebola patient under the same rules and regulations set out by the CDC,,,
Common sense says waste would have to be directed to a tank and not the aquifer.
John Hanson 1781-1782 | October 13, 2014 at 2:39 PM |
Ebola is to kill black people , white man gets Ebola and lived , white woman get Ebola and lived, black man get Ebola and dies, it seems the plan is working very well by whites and the CDC master plan.Clear the land of Africa so the whites can take it,
……………………………………………………………………………………….
But the many civil wars in Africa over the last years has wiped out more black people there than we can imagine, and at the hands of our very own blacks. Even Blacks Ordering Liquidation of Africans.
1967-1970….Nigeria and Biafra………….800.000 deaths
1969-1979… Idi Amin regime……………..300,000 ”
1972…………Burundai Civil War………….300,00 ”
1974-1991…Ethiopian Civil war………….1 Million ”
1975-1978..Menghitsu -Ethiopia war……1.5 Million ”
1975-2002..Angolan civil war………………500,000 ”
1976-1993..Mozambique Civil war……….900,000 ”
1982-1990..Chad ……………………………..40,000 ”
1989………..Liberian Civil war………………220,000 ”
1989 ………..Uganda………………………….30,000 ”
1991-1997…Congo civil war……………….800,000 ”
1919-2000…Sierra Leone civil war………200,000 ”
1993-1997..Congo Brazzaville civil war…100,000 ”
1993-2005…Burundi civil war………………200,000 ”
1994…………Rwanda civil war………………900,000 ”
2001………..Nigeria vs Boko Haram………1700 ”
2002 ……….Cote de Ivore……………………1000 ”
2003-2009..Sudan Vs Darfu………………..300,000 “
ac | October 13, 2014 at 4:52 PM |
RE GP
knowing all that has said about the virus at present would you treat an Ebola patient under the same rules and regulations set out by the CDC,,,
I NO LONGER TREAT PATIENTS LOL SO IWONT BE TREATING ANY EBOLA PATIENTS ANYWHERE ANY TIME ——— I RETIRED LOL
ALSO I TEND NOT TO GIVE MUCH MEDICAL ADVICE ON BU ANYMORE. I RETIRED FROM THAT TOO!
WHY SHOULD I BE CHALLENGED BY MEDICAL ILLITERATES LIKE YOU KNOW WHO OR WHY SHOULD I BE SUBJECTED TO THE SAME JACKASS SAYING THAT MY POWER POINTS COME OFF THE NET?
ALL I DOING NOW IS CHALLENGING AND MOCKING
THE 200 PLUS DRS IN BIM CAN TEACH YOU FOLK PLUS THE CHALLENGING MEDICAL ILLITERATES
WHEN I AM BORED I NOW COME HERE TO GET A FEW LAUGHS AT THE SHITE I SEE WRITTEN HERE IN THE RUM SHOP
Dompey | October 13, 2014 at 4:44 PM |
seems that you are correct in your opinion
GP why the tirade, the response is unnecessary and uncalled for a simple answer of YES or NO would have suffice but guessing from your response i gather if you were practicing medicine there is a high probability that the answer would be NO, at least truth fulness was all that was required as a response not a long drawn out dispensation of the TRIAL and TRIBULATIONS which you have endured on BU .
ac there you go— THE USUAL
dont I have a right to answer in my way just as you answer SSS and others?
most likely the CDC is still trying to prevent a pandemic of FEAR from spreading through out the health system, and rather than facing the probability that the virus can be contracted even when all procedures are followed they are blaming the victim ,who at this point seem to be confused and might even be pressured by the CDC as to how she might have contracted virus
London hospital in chaos after ‘Ebola patient’ walks into casualty
RE trying to prevent a pandemic of FEAR from spreading through out the health system, YOU MEAN THROUGHOUT THE WORLD! LOL LOL
@ David | October 13, 2014 at 5:53 PM |
If the Ebola virus can only be transmitted by being in direct contact with the body fluids of the infected person why all the head-to-toe covering even on those only in the room of the suspected Ebola carrier? Wouldn’t having a ‘healthy’ suspicion of skepticism about the mutation ability of the virus to become airborne be something to neither sniff nor sneeze about?
So David now that Zombie Ebola has entered the UK what is Bim going to do? Start screening those money-bringing folks arriving from the UK?
Can we expect the Bajan Immigration and Customs officers to be outfitted in spacesuits when Virgin Atlantic or BA lands at GAIA or would the spraying of the cabins with so-called harmless aerosol disinfectant be sufficient?
Just being the devil’s advocate as Ebola runs its course!
Ebola: Five ways the CDC got it wrong
http://www.cnn.com/2014/10/13/health/ebola-cdc/index.html?hpt=hp_t1
CDC is LYING
http://www.cnn.com/2014/10/13/health/ebola-cdc/index.html?hpt=hp_t1
@Miller
Interesting times ahead. We have to make up some things as we go along. The same occurred with SARS no?
AC; Good links above. The BU team has been on the ball so far. Good work!
@ GP
I found your summary of Charcot’s Triad most interesting. I know a MS patient and earlier in the person’s life, before MS was evident and diagnosed, the person did sometimes have staccato speech.
From this, is it then likely that such was an early sign of MS?
Thank you.
@ GP You are not gloating quoting biblical prophecies about Ebola
Only Jah know
http://youtu.be/PNFJCG0-UsU
Seems so Crusoe
Sometimes one has to make the diagnosis before all the features become evident. I had a teacher who would say waiting for all the symptoms to be evident to make a diagnosis is the SIN OF DIAGNOSTIC GREED
Scenario.
Guest at a hotel falls ill and is taken to a doctor or a clinic like Sandy Crest.
Said guest has symptoms of Ebola.
Has the MOH in Barbados created a protocol for dealing with this?
GP
Hope that you are really putting together something for the students of medicine who read this blog, especially now that you don’t have a daily work schedule.
You will not leave them without your input in 2014. We won’t have it. Remember they say you can find a Barbadian everywhere and it is your Barbadian duty to apprise us on this matter.
We have not told you that we love you for a long time and so we say we love you and appreciate you.
We wait patiently for your research.
GEORGIE PORGIE | October 13, 2014 at 7:19 PM |
Seems so Crusoe
Sometimes one has to make the diagnosis before all the features become evident. I had a teacher who would say waiting for all the symptoms to be evident to make a diagnosis is the SIN OF DIAGNOSTIC GREED
I agree with yoy here. My nephew was taken to Emergency several years ago with fever, vomiting and head ache. the young Dr. told my sister he suspected meningitis, but was not sure. He told her waiting for tests results could be disastrous, so he was going to start medicating him for meningitis. Good thing he did – My nephew is alive today. Stone deaf, but alive and kicking. As he was only 20 years old, the government’s Ontario Hospital Insurance plan gave him two cochlear ear implants, costing some $40,000. .Normally they would give just one. In addition he got two pairs of rechargeable batteries which are held to the head by magnets placed under the scalp. He hears better than me
Nice to see you Pat
That’s a nice case you have cited
Dr made the correct diagnosis on the basis of a high level of suspicion—and HIS KNOWLEDGE OF COURSE.
YOU CAN NOT MAKE A DIAGNOSIS THAT YOU DONT KNOW THAT EXISTS