Thursday, October 16, 2014

U.S. Hospitals Prepared for Ebola?

Hi Ferfal,
I was just looking through your site. Looks like there has not been much on ebola. You may recall I am a licensed healthcare person, although not a nurse. I have a personal intellectual interest in infectious diseases, so I get this email digest from the International Society for Infectious Disease. They had a period when it seemed like no messages were going out, but they seem back in the game now.
As a result, I guess I have been following the ebola outbreak since pretty close to when it started. I also just have kept an eye out for other articles about it. I distinctly remembered in the summer reading that the people who purport to study this kind of thing were heavily implying that it could be transmitted by droplets. The CDC et al. always go out of their way to insist ebola is not airborne. That is technically true, but to the layperson I think they don’t make a distinction between droplet transmission and airborne. Already at the beginning of August, the health authorities were giving guidance that was clearly intended to avoid droplet transmission.
Anyway, you know the CDC now has been going on and on about we have such a great healthcare system in the US, etc etc. I think anyone who actually works in the industry would be quick to tell you differently- including me. Last winter we were constantly running short of simple masks during flu season. So it was not hard to figure that they would not have a good supply of space suits for ebola care.
Just because I have been keeping an eye out, I have seen a few memos go past in the work email since the start of the outbreak, but they all have been beyond superficial. There has been no education, no drills, no stocking up that I can see, no designating areas to care for suspected cases, nothing like that. The vague, ebola related emails were just mixed right in with employee parking spot winners and foolishness like that.
Just yesterday morning we got an email ‘[Our hospital] remains prepared to deal with Ebola’. It was almost like a pep talk for people who already worked there. The only substantive bit was to tell people to look at the FAQs on the CDC website. There was nothing like ‘personal protective equipment can be obtained from so-and-so’ or ‘please put any suspected ebola cases in room 2′ or anything that would be immediately useful.
So last night the emergency department had someone come in who fit the profile for a potential ebola case. Guess what? No one knew what do to. They were calling around to see if anyone knew what to do, looking on google to find out what kind of PPE they should be wearing and how to isolate the patient.
I was surprised to learn that the people working didn’t even know about the potential for infectious droplets, because I had thought that was already established back in the summer. So basically, it sounds like it was a big clusterf*k. This is at a community hospital, so maybe they didn’t think it would be a problem for them.
I am on the email list from another hospital I used to work at- i.e. a ‘big city hospital’, and they were doing a training session today on PPE apparently. It says ‘ebola overview, resources, donning and doffing of PPE’. I only got the email first thing this morning which leads me to believe it was probably put together at the last minute.
I personally have not heard of anyone, anywhere, saying anything like, ‘Wow, we have done so much training for ebola,’ or ‘wow, my hospital is really on top of this.’ Everyone is like, ‘What’s going on?’
Just thought you might be interested.
– JM

Hi JM,
As you know I have a very practical, no-nonsense approach to modern survivalism. I especially try to keep a level headed attitude and avoid fear mongering. Having said that, I just cannot believe how irresponsibly ebola is being handled.
“NOT EASY TO CONTRACT” this is literally what cnn has to say about ebola. Of course then it goes on to say in the same video presentation that it is carried in bodily fluids, blood, saliva, tears, mucus, feces, urine, sweat, semen and vomit. How can we say on one hand that direct contact is needed to get infected, but on the same video clip they say that saliva and mucus carries ebola and it can get into your body through your nose, mouth and even your eyes. Cant anyone makes the elemental connection between saliva and the thousands of droplets flying after a patient sneezes or coughs? Just yesterday I saw CNN’s Dr. Sanjay Gupta argue with ebola expert David Sanders. Sanders was explaining the possibility of ebola being spread through aerosol transmission (sneeze, cough, vomit) but Gupta cut him short claiming the chances of such a transmission were so small, it was not worth talking about while other things were more important…??? You’re talking about ebola, and you don’t think its important to learn how you can actually catch it? I can’t believe relatively smart grown persons are either a) so stupid b) so irresponsible. The only option left I see is that these claims we see on the press are very misguided attempted to keep people calm. In any case, it is very concerning to still see talking heads in the media claiming ebola can’t be transmitted in such a way.
Thanks for sharing your experience JM!



Anonymous said...

Ebola doesn't need to (and probably won't) become officially airborn. The virus is incredibly dangerous in its current form. Because people are most infectious toward the end and after death, the people most likely to catch the disease are healthcare workers and those who dispose of bodies.

The virus really goes after the healthcare system, taking out the most useful resource for fighting back. When you are afraid to go to the hospital because that's the center of the outbreak, commerce and distribution of needed supplies may break down as well. Many people in Africa are dying of hunger because no one is bringing food in to some districts and it's dangerous to leave home.

Considering how poorly the CDC is doing, I don't think the US can handle 50-100 outbreaks before the medical system is overwhelmed.

The best chance we (and Africa) have is that a vaccine or treatment is developed quickly.

Anonymous said...


You are the voice of sanity, Ferfal. TERRIFIC background info for those of use who don't understand medicine or viruses. Your site is fantastic and your info is FIRST CLASS.

Don Williams said...

1) Some of the US News Media were smearing the Texas Hospital (where the two nurses got sick) for incompetence --but it looks like the problem was that the US Center for Disease Control (CDC) put out INADEQUATE guidelines in 2007 and did not update them.

A major shortcoming was not having nurses wear hoods and leaving the bare skin on their scalp/neck exposed.

2) CDC are currently revising their guidelines for what protective gear to use , the procedures for donning and removing it,etc, with the help of the Doctors Without Borders (aka
Medecins Sans Frontieres) --who have far better guidelines.

The Doctors Without Borders' manual for dealing with Ebola is the best I have seen on the subject and is available here:

3) The Commander in Chief of the US DOD's Southern Command (Mexico, Latin America, South America) has noted that if the Ebola pandemic spreads via air travel from Africa to hot, humid Latin America, it could trigger a massive rush of scared refugees to the US southern border:

4) Washington will almost certainly keep Ebola from spreading into the USA. However, Any survivalists wanting to have Personal Protective Equipment at home better grab it now -- some items already are sold out/not easily available due to US aid going to Africa.

Two possible uses for the PPE:
a) To care for sick family members if hospitals are overwhelmed

b) To be able to go out in public (buy groceries, go to the bank, go to work , etc.)

Don Williams said...

I have also been looking into the details of Personal Protective
Equipment recommended by WHO, CDC and Doctors without Borders (MSF).

For what it is worth, what I found is as follows:

1) Paul Roddy, Independent Consultant in Barcelona, issued a call for an updated Ebola manual in Viruses (Sept 30, 2014). Google "A Call to Action to Enhance Filovirus Disease Outbreak Preparedness
and Response"

2) Roddy cited several existing manuals:
a) Esther Sterk (MSF)'s 2008 manual "Filovirus Haemorrhagic Fever Guidelines", which I linked to in the previous post.
b) WHO's August 2014 "Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola" at who-ipc-guidance-ebolafinal-09082014.pdf
CDC also issued isolation guidelines --including PPE recommendations -- in 2007.

3) Roddy suggested that WHO , MSF and CDC should develop an updated, joint set of guidelines. He indicated that MSF has not updated the 2008 manual. Even so,
the 2008 MSF Guidelines seem superior (in my opinion) to WHO and CDC's 2014 guidelines -- e.g, in calling for a covering for the head.

CDC's site indicates they recently (2 days ago) started
working with MSF to use MSF's African experience to update their (CDC's) isolation guidelines/ advice on Personal Protection Equipment,etc. E.g to add double gloves, hood to cover the head and neck,etc.

4) A study of photos of MSF workers in Africa indicates MSF has added some additional items to their guidelines. For one thing, they use what appears to be
N95 respirators of the duckbill form. But they also put a surgical mask over top of the duckbill respirator with a slit to expose the very end of the duckbill to the air.

My speculation (and that is all this is) is that the mask covers most of the respirator to prevent the surface of the respirator from becoming contaminated --
for fear that the virus can penetrate a N95 respirator as the respirator becomes soggy with water vapor exhaled by the worker. Another possible reason is that the surgical mask is put over the respirator to cover any skin exposed at the edge of the respirator.

Also the outer gloves appear taped to the coveralls.

5) Some US makers of protective coveralls (Lakeland, Dupont) have noted sales in support of the
Ebola relief effort and have noted US standards for such use -- that the coverall must be impervious to blood borne pathogens and include such features as taped (vice merely sewn) seams.

The technical standards cited are
the USA ASTM F1671 and European EN 14126. I have also seen some
discussions arguing that Tychem is better than Tyvek. There is also the question of whether a particular model can be reused by soaking in bleach water versus
disposable models that must be burned.

6) Also, the MSF workers appear to be using various models of goggles with indirect venting and anti-fog lenses made by UVEX. The low-cost A610S model appears to be used by the rank and file workers in Africa while the
doctors appear to use more expensive models. Models with foam rubber edging appear to be avoided --probably can't be sterilized in bleach water.

7) I would appreciate it if someone more knowledgable could provide better info.

8) I think survivalists would be better served by looking at rubber PPE that can be washed in bleach water and reused vice stocking bales of Tyvek disposable coveralls/booties, etc that have to be burned after a single use.

Don Williams said...

An Update: The 2008 MSF manual I mentioned in an earlier post above was a summary , albeit
a book size summary. The full, detailed MSF manual for Ebola, dated 2007 and titled "Ebola & Marburg Outbreak Control Guidance Manual, Version 2.0"
is here:

The full manual has MSF's detailed equipment list, why they chose the equipment they
did (e.g, that the coveralls or gown has to be waterproof) and the specific models they chose. However, I don't see some of the models they mention --e.g, the
TopGuard Tyvek-ProTech overalls --currently being sold in the USA. MSF appears to get a lot
of their stuff in Europe and the overalls may be sold there. Alternatively, they may have
been what's currently called Tychem.

The orange duckbill respirator seen in photos of their African personnel may be the
"Kimberly-Clark Professional Fluid Shield 46767 PFR95 N95 Orange Regular Particulate Filter
Respirator and Surgical Mask Fluid Protection, Safety Seal Film- pouch style".

Note that MSF says NOT to use a respirator with an external valve. Unfortunately, that
means the respirator will soon become clogged with exhaled water vapor. I seen reports
that MSF doctors can only work about 45 minutes -1 hour in their gear before they have to leave Ebola patients and remove it.

Which means an ENORMOUS logistics requirement since part of
the gear is then burned and has to be replaced with another set.

From the photo I provided in the previous post, The reuseable items
(soaked in bleach water and air dried ) appear to be the goggles,heavy rubber gloves (doctors
use disposable surgical gloves), high rubber boots (in case dress-like gowns worn vice overalls),
and plastic aprons.

Anonymous said...

Not sure if anyone will see this here in the comments. I sent the original email in this article. So the next day after the events of this email, I think word got a round, and a bunch of hospitals had hasty information sessions. Word gets around pretty quickly in the healthcare world, particularly about screw-ups.

So that same next day, we had an announcement that they were having a disaster drill. I was in an office with my boss. So I didn't see what was supposed to be happening. I asked someone afterwards, and they said it was an earthquake drill. I thought they were joking. But I asked around, and even after not knowing what to do with a potential ebola patient, they really honest-to-god decided they would be better doing an earthquake drill in the NE USA.