Presbyterian's Nurses Are Pushing Back on the CDC and Hospital Over Handling of Ebola

There's a reason nurses are nurses, and not doctors.  This letter seems to echo that sentiment. 

The only person responsible for this outbreak is the African man named Duncan.  He lied to come into this country, and put at risk millions of people for his own selfish purposes. 

In all honesty, while the morons in the CDC contributed to the problem, I cannot fault Presbyterian's reactions to this - especially since no protocols from the CDC existed for 

treating Ebola patients and isolating them.  

It is clear the new CDC is took distracted by "gun violence", violent video games, dangers of playing Tag, proper school nutrition, bicycle helmets, and a number of other politically inept (regardless of correctness) that has nothing to do with COMMUNICABLE DISEASES which is what the former CDC was about before Obama turned it into a political entity.  And, now, we are seeing the serious errors that change caused.

The CDC told the traveling nurse that her fever was not a concern until it hit 100.4 degrees, so flying was ok.

The person(s) who determined that are likely unionized and will get a raise soon.

When I say that they need respirators as part of the PPE, I'm "panicking" and trying to incite some sort of what-have-you, right?

Maybe now that the nurses are calling for it, Myrna will decide that we have always been at war with Eastasia, respirators have always been part of the PPE, and chocolate rations are being increased from 30g to 20g.

From the follies:

“[A travel ban] is something that is not on the table at this point,” White House press secretary Josh Earnest explained on Wednesday, claiming shutting down commercial travel would “prevent the expeditious flow of personnel and equipment into the region.”

I wonder if we could get the Canadian military to lend us some planes - and the U.S. military might consider buying one or two for emergencies like this.

The bottom line: It doesn't help a bit to know what to do, to have a protocol, if the treating hospital doesn't follow it. Before speculation goes crazy and conspiracy theories sprout like toadstools, how about we do the obvious stuff? There is still no evidence whatsoever that these measures don't work or that Ebola is spread through some mysterious mechanism we don't know about.

@blase1 Prior to2009, when Obama was sworn in and changed the mission of the CDC (Communicable Disease Center) to some political support group on "gun violence", children playing "Tag" and "Not It", effects of Global Warming on health, boys and girls wearing helmets on tricycles, unicycles, and bicycles, the CDC was the gold standard for research, diagnosis, treatment, and prevention of communicable diseases (including epidemics and pandemics), and health alerts as well as notices of promising treatment or cures of communicable diseases -- and their morphing into other forms. 

It is outrageous what Obama has done to the CDC and its credibility, as well as its standards for performance.

One of the greatest advantages of having the CDC was having an immediate and centralized authoritative point of communication about diseases - not only in America, but around the globe. 

@Noreii This.  All the nurses I've known were good people who do some truly dirty jobs, but they always go with what the doctors tell them, even when it makes no damned sense to a normal person.  If you ask them why, they say, "I just do what the doctors tell me, they're the doctors."

The CDC goons are doctors, so the nurses are going to do whatever they tell them.  It's like the military, with officers and sergeants.  You don't get pissed off at the sergeant who was following orders, you get pissed off at the officer who ordered it.

@TheRuddSki US military would never be so crude as to travel on government owned aircraft.  They charter with an Israeli-owned private airline.  I'm sure it has nothing to do with the company's excellent safety record and security expertise.

@bmarvel Google Dr Peter Jahrling, he's been studying this for years, and he says this strain of Ebola is more virulent by far than previous strains.  He is dumbfounded that screening of travelers wasn't done (CDC DOES have the authority to do this, in fact it's part of their mandate, regardless of Mav's protestations), and is worried that the US is moving too slow to get ahead of the virus.

@bmarvel Except, you know, all the people who follow them in Africa and still end up infected.

And the ones here.

@Greg820 

The CDC has the obligation to ensure that the facility has the expertise and equipment to handle such a situation

I would appreciate if you can direct me to where CDC has been given "the obligation" and most importantly the power "to ensure" any hospital acts in the proscribed manner.

I've searched and all I find is that CDC lacks ANY authority whatsoever to force a hospital to do much of anything....

@everlastingphelps depends on the order.  A sergeant had damn well better have the balls to defy an illegal order, or he doesn't deserve his stripes.

Stupid orders on the other hand, sometimes it's best to follow those, just for the 'told you so' opportunity.

@RTGolden1 @bmarvel I have no problem with intense screening of airline passengers from the affected area. Even quarantine, if it comes down to that. 

My contention is that Presby, the only U.S. hospital so far faced with this situation, does not seem to have fully implemented the safeguards and protocols already in place.  That would fully account for the two cases after Duncan, without having to evoke blog-generated theories about this and that.

As far as this round of Ebola being more virulent, that's a scientific judgment that Dr. Jahrling and his colleagues will thrash out in the coming months. Obviously, he's not the only one studying the virus. 

I'm not sure if he means by "more virulent" that it's more deadly once it attacks -- 70 percent deaths as opposed to 47 percent -- or whether it's more easily transmitted. If the latter, how come only two cases so far? What about Duncan's family, neighbors? Those who shared the hospital emergency room with him on his first visit? I would think by now, or soon, Ebola would be all over the place. But we'll see, by and by, won't we?

@RTGolden1 

come on RT, I never made any claims about "screening of travelers". you're better than that aren't you?

My comments are about the capability of the CDC to regulate or compel actions at hospitals, and the observation that all hospitals are regulated by State agencies with no federal regulatory oversight.

@everlastingphelps @bmarvel So your argument, phelps, is that health care conditions in Africa -- you've been reading about these conditions, right? -- are in line with CDC protocols? 

@everlastingphelps @bmarvel

or the ones here who don't follow them. like apparently Presby...

@dougsterfresh "Who really needs the CDC to tell them to take Ebola precautions and protection gear very seriously?"

Presbyterian, apparently.

@mavdog @Greg820 The thing is, mavdog, all this is a rebuke to those who would reduce the roll of the federal government in state and local affairs. 

Who would be the first to whine if the CDC stationed its people in privately operated hospitals and clinics to make sure federal protocols are followed in emergencies such as the Ebola outbreak? The same Reduce-Government folks, the same privatize-healthcare cadre that are now howling for an federal embargo on travel to and from Africa and blaming CDC, one of those agencies they underfund and dis-empower. 

How do they imagine a for-profit, private-insurance based health care system would  meet the Ebola emergency? By putting its bean-counters to work on a cost-benefit analysis? By putting it to the vote of stockholders? What if that private insurance company decides there's no money in Ebola coverage and the risk of catastrophic losses is too great? Kind of like Big Pharm deciding not to invest capital in Ebola research or drug production because there's just no prospect of big  bucks.

@mavdog @Greg820 http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html

http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html

http://www.cdc.gov/phlp/docs/ph-emergencies.pdf  pg7. Federal Authority to prevent the spread of communicable diseases...."from foreign countries... or from one state to another..."

You keep harping on the CDC being a powerless organization, but you're wrong.  It has proven to be an incompetent organization, but that incompetence is the product of a lazy bureaucracy, not from lack of authority.

This search didn't take long, by the way.

@heather30 @reebola @JustSaying In case anyone missed all the outrage and emphasis the first time around?

@bmarvel @RTGolden1 From what I've read, it is the decreased mortality rate that has led to its spread.  Other strains have had 80-95% mortality rates, which means that it kills the victims so quickly that it burns itself out.

This one seems to be around 50%, so it kills them more slowly.  Since you become more and more infectious as the infection progresses (both from the viral load increasing and from you becoming a practical fountain of infectious fluids, as you bleed from the ass and eyes, your skin sloughs off, and you have explosive projectile bloody vomiting and diarrhea at the same time) you are more of a threat to the people taking care of you (healthcare workers in America) than the general public.  The longer it takes you to either die or recover, the more time you have to infect more people.

Duncan came to the hospital late, but it was still early enough that he doesn't seem to have infected the general public.  (WHO reported on the 14th that the incubation time is up to 42 days, not 21 as earlier thought.)  But as he got sicker, the level of protection used needed to go up.

It also means that the threat of infection from the nurse on the plane was also very low, since her infection had just started.  On the other hand, "very low" is still way above zero, and zero is what you want when getting infected means you are a coin flip away from death.

@bmarvel @everlastingphelps My argument is that western trained doctors, like the 16 infected (9 dead) from Doctors Without Borders, follow the protocols, yes.

Do you think that they suddenly become untrained because they take a flight overseas?

@mavdog @everlastingphelps The best reports I've seen (based on the charts released to the public) is that the second nurse did not treat Duncan until the higher level protocols were in place.

@bmarvel @mavdog @Greg820 Right, the "all libertarians are really anarchists" straw man.

Would I be bitching if the CDC was trying to regulate all the hospitals in all the functions?  Absolutely.  I would be bitching the same way I bitch if our military was trying to occupy every country in the world.

An outbreak, however, is what they are here for, and it is what is happening. Their fucking name is the Center for Disease Control and Prevention.  It is their reason for existing.

So, just like the military, there are situations where they should roll in in force.  An outbreak of a 50%+ mortality hemorrhagic fever is one of them.

Nobody is un-inviting the CDC.  No one is arguing about whether or not they should be there.  They are there, and just not doing their job.

@RTGolden1 

The regs say that at a "point of entry" the CDC has authority, or "to take measures to prevent the spread of communicable diseases between states".

it also says "State. local and tribal authorities: Enforce isolation and quarantine within their borders."

So if the person isn't travelling into the US, or the person is not travelling between states, it seems the CDC isn't involved.

In this case the person (Duncan) was already inside the country, and stayed within a state once diagnosed.

@Greg820 

This is not a question of "semantics".

Either the CDC has the regulatory power or it doesn't.

The CDC decided to keep patent zero there

really? can you point me to where it is stated that the decision was CDC's?

What I see is a lot of finger pointing at CDC, while I can't find where CDC has ever been given the ability to make decisions at these hospitals.

@BillRR @bmarvel @RTGolden1 Presby is not-for-profit, but it is privately operated, which means it is under great pressure to contain costs. 

But I gather from your comment, BillRR, that you favor some kind of government provided health-care arrangement rather than good old American capitalist free market for-profit medicine. What are you -- Some kind of Socialist/Marxist/Leninist/Maoist??

@everlastingphelps 

@everlastingphelps @bmarvel

Reports I've seen is that impossible to follow protocols in Africa because shortage of supplies, lack of sanitary conditions, isolation, social factors. Even Doctors without Borders pleading for additional material, supplies.

Channel 8 just reporting the second nurse did, in fact, treat Duncan. Based on Presby's nurses' complaints to national nurses association, the protocols were never fully followed at Presbyterian. No covering for shoes; no secure elastic on sleeves, wrists; face and neck uncovered except for mouth, nose; gowns loosely fastened in back. Abundant vomit, diarrhea in the environment; bedding and other contaminated material left in vicinity.  Likely the hospital was utterly unprepared for an emergency of this kind and magnitude, protocols poorly understood. 

@dougsterfresh @bmarvel The other problem is that the CDC has two sets of protocol now, one for Africa and one for America, and the African set is much more thorough, if you can wrap your head around that.  The African protocol has rinsing with bleach and washing the gloved hands between every step, whereas the American protocol seems to be, "just shuck it all off, you're good."

@everlastingphelps @bmarvel @mavdog @Greg820 "Right, the "all libertarians are really anarchists" straw man."

If you can find the word "anarchist" anywhere in my comments, phelps, the duck will fly down and pay you $50.

By the way, I do make a distinction between anarchists and libertarians.  Libertarians don't throw bombs. 

@everlastingphelps @bmarvel @mavdog @Greg820 If you fund and authorize an agency for a minimum of  interference with state, local and private interests, this is what you get when interference is actually needed. Your darling, Rand Paul, actually proposes to cut the agency's budget another 20 percent. 

@mavdog @RTGolden1 Please explain how the CDC is supposed to take steps to contain an infectious outbreak (I will admit here that what we have is not yet an outbreak) between states if they have no authority to dictate how states and hospitals carry out treatment?

I get where you're coming from, but there comes a point where federal agencies' responsibility to protect the greater common good trumps state and local autonomy.  Would it take something similar to martial law for the CDC to take the lead?

@bmarvel @BillRR @RTGolden1 You do realize that there are different markets at play in our economy, don't you BM?  I'm a free market supporter, for markets that ought to be free.  That would mean those markets where there is healthy competition and consumers can reasonably be expected to make informed decisions.

Then there are Utility markets, where there often is no competition and the consumer is stuck with a single source.  When those get de-regulated, the opposite of free market economics happens, a-la the Texas electricity market.  There are lots of brokers selling the product of one provider and prices are going up, up, up, even though generating costs are going down.

Then there are professional markets, like health care and lawyers.  Yes there is competition, but the knowledge to make informed decisions (as evidenced by the amount of contradictory 'facts' presented in these ebolaboards) is either scarce or difficult for the average person to sift through and make informed decisions.  These need to be regulated, especially health care, which is one of those 'greater common good' things our constitution is supposed to provide for.  Which is why, although I am a free-market supporter, my biggest gripe against the ACA is that President Obama abandoned the national single-payer plan, caving in to insurance interests instead of working for the common good.

@everlastingphelps 

there are different sets of protocols for the US and Africa as the protocols for Africa state "The recommendations in the manual make use of common, low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting". The expectation is there are different and improved supplies in US hospitals. That doesn't seem to be a huge leap in logic does it?

Rinsing with bleach is not "more thorough" if more effective sterilization materials are available.

http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

http://www.cdc.gov/vhf/abroad/vhf-manual.html

@bmarvel @everlastingphelps @mavdog @Greg820 You painted limited government libertarians as no-government anarchists.  Of course you didn't use the word -- that's how straw man arguments work.

@bmarvel @everlastingphelps @mavdog @Greg820 I'll believe that they can't handle their core duty while still taking a 20% reduction in their budget increase rate (which is a far cry from an actual reduction) when they aren't spending millions on things like:

Gun violence studies

transfat and soda bans advocacy in NYC

Motorcycle helmet studies

Playground equipment studies

etc etc etc

@RTGolden1

Apparently there is no current CDC ability to quarantine a person that is infectious, it is up to the State to establish the quarantine.

The CDC, as you showed, does have authority at places of entry. or when a person is travelling across state lines. otherwise, they can't tell the state, or the local, public health agencies what to do, they can only offer advice.

There is the possibility that an Executive Order can be issued that would apply specifically to Ebola, but even then it would not allow the CDC to order State or local agencies to do anything but rather expand the CDC's ability to stop travel/transit and quarantine those suspected of infection.

It's our country's Federalism, and the power of the States. Seems archaic, no?

good read in today's WSJ about this very subject.

@RTGolden1 @mavdog It's all semantics anyways.  Even if they don't have statutory power, it would be malpractice on its face to defy the CDC recommendations, so they might as well have the power of law.  No hospital is going to willingly risk that lawsuit.

@Greg820 

I'll take that as an admission that you cannot provide what I asked.

@RTGolden1 @bmarvel @BillRR The free market cry, Golden, is ever let the market sort it out. But choosing which markets should be free is not a free market exercise. It depends on other values. The free market is not, as some would wish, a final determiner of value.

@doublecheese @bmarvel @everlastingphelps You don't win arguments with "probably," doublecheese.

The protocols for Ebola are clear and would work. If they were followed. They weren't. We know that. We have a bill of particulars on that. The CDC promulgates the protocols. It is not authorized to sit in emergency room and enforce them. 

@mavdog They would be better served by following the military's NBC decontamination/re-suiting protocols than the CDC's suggestions.  And with the emergence of MRSA and other superbugs, I'm actually surprised hospitals in the US aren't better equipped and trained for minimizing contamination than they are.

I find it odd that the military trains religiously in these steps.  We trained at least once a month, for hours, and our protective posture and decon was not even counted on to give us even odds for surviving.  Why wouldn't a hospital, with or without CDC guidance, train their staff to give them the same fighting chance?

@mavdog The issue isn't the type of sanitizer used.  The issue is that American protocol lacking any kind of sanitizer (including basic hand soap) on the gloves in the intermediary steps.

@everlastingphelps @bmarvel @mavdog @Greg820 

Uh uh, phelps. You can't lose my argument for me by putting things into my mouth I'm not saying. (Something I believe you've accused me of doing.) Words and sentences have meaning. They're important.

To refresh your memory, I said: "those who would reduce the roll of the federal government in state and local affairs."

@everlastingphelps So far, phelps, guns, faulty playground equipment, soda obesity and guns have killed more Americans than Ebola. But it's early yet.

@everlastingphelps 

The guidelines say to not reuse gloves, they do not require use of a sanitizer in the "intermediary steps".

There's also the guidance "Hand hygiene following glove removal further ensures that the hands will not carry potentially infectious material that might have penetrated through unrecognized tears or that could contaminate the hands during glove removal".

http://www.cdc.gov/hicpac/2007IP/2007ip_part2.html#e

@Greg820

I am in a field that deals with government regulation and industry supervision, which is what this subject covers.

I also am aware that "any idiot can have an internet connection" and make claims that have no basis in fact.

When you can locate anything that supports what you claim, let us know.

@doublecheese @bmarvel @everlastingphelps He's probably right -- for Africa. If CDC protocols are going to get people sick here, we'll have to find a place where they are actually being followed --- obviously not Presby --  and see who gets sick. Two cases so far among hospital workers who were not following those protocols does not constitute an adequate sample. Not even "probably."

@doublecheese @bmarvel @everlastingphelps So far we have two sick nurses. We know why they are sick. They failed to follow --or more likely were prevented from following -- the established protocols for dealing with Ebola. If the good doctor is correct, where are the other Dallas cases?

@Mervis @RTGolden1 @mavdog fair enough.

@mavdog @everlastingphelps And that doesn't work.  You get contamination on the gloves from removing, for example, the gown, and then because you did not wash your gloves, you contaminate your face taking off the mask.

We need to be washing the gloves between items when removing PPE.  That's how it works in the BSL-4 centers, where the workers aren't being infected.

@athenian200 "Why do people want to reduce the federal government's rolls?" Because sometimes I can't spell.

@everlastingphelps 

"Disposable gloves must be worn underneath cabinet gloves...Do not wash or reuse disposable gloves. Dispose of used gloves with other contaminated laboratory waste".

http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf

@mavdog @everlastingphelps 1 - those are the cabinet lab rules, for when you are using one of the Homer Simpson style isolation boxes.  You want the suit lab procedures.

2  - 4. Decontamination of outer suit gloves is performed during laboratory operations to remove gross contamination and minimize further contamination of the laboratory.

@everlastingphelps

those are in the suit lab rules

"Homer Simpson style"???

@mavdog http://deadhomersociety.files.wordpress.com/2012/08/simpsonanddelilah10_thumb.png

Or a real-world example:

http://www.germfree.com/wp-content/uploads/SEAiii.jpg