loves2read, in those types of management situations, the best, most caring professionals who care enough speak out will just leave, while the least caring, "it's just a pay check" folks, stay.

I've always thought that the most effective, most powerful management teams welcomed honest criticism as their goal is to improve the overall operation. And as so many quality-oriented management systems have proven, it's those on the front line who know the truth of what's happening....by the time it reaches the upper tiers, it's so sugar coated as to be unrecognizable. But it takes a high degree of self confidence and a willingness to put aside managerial arrogance to achieve that...it's rarely done.

I will do the same Tina. I accept your apology and I hope you accept mine.

tina: "Welcome to all the new posters - I'm enjoying the added input."

Tina: "Oakley, I could care less what you think."

Tina: "Oakley - let's try this. Let's TRY to be pleasant to each other here on the board."

Not nice, Tina. Downright rude, in fact.

If you don't care what someone things, just don't respond to that person. But telling someone you don't care what they think is not "trying to be pleasant" with that person.

Same time, Oakley, disagree w/u about Nancy Snyderman. I suspect she is genuinely sorry…for causing an uproar among stupid, fearful Americans. Ebola is NOT transmittable when there are no symptoms.

Everyone needs to take a chill pill re: ebola in the US. One way to to that is to stop worrying about ourselves and consider those who are actually on the front lines of this disease and the places where it actually is spreading like wildfire, namely W. Africa.

Americans can be so self-absorbed, to the point of losing all perspective.

Thanks for your input Tib - but I think we can work it ourselves.

Where's Nicole Lurie ?

Try harder, tina

It does seem pretty consistent that transmission really occurs only during the sicker stages of the disease, not at early illness. However, I am waiting to hear more details about the case in Spain of a "low-risk" contact of the nurse who might now be ill. If this person also has Ebola, I wonder just how sick the nurse was at the time of their contact. I thought she was hospitalized fairly early.

Tina and I are working on this and we're good. :)

Tib, the thing is, Nancy could have come down with a fever as soon as she got home from the restaurant. That's why she and her crew were asked to stay in quarantine. She was only sorry for the concern it caused, but she was in no way sorry for her actions as being wrong. She's shifting the blame.

Just like the nurse who had the low grade fever. She shouldn't have even asked if it was okay to fly, it's all basic common sense. Stay put, stay out of public places.
Don't put the blame on he CDC.

None of us can assume anything at this point, not even how it's caught or when it's contagious.

Oakley, the nurse KNEW she had a fever when she wanted to get on the plane, i.e.: she was presenting with symptoms. Snyderman was not. ebola is only transmittable when a person has symptoms.

"It does seem pretty consistent that transmission really occurs only during the sicker stages of the disease, not at early illness."

But what's interesting about that is Kent Brantley's case. He feels 100 percent certain he did NOT contract it in the isolation ward of that African hospital. He said maybe he got it counseling family members. So were the family members sick and vomiting at the time?

And I don't think the NBC camera was in contact with anyone that was sick.

" ebola is only transmittable when a person has symptoms."

And that would be all well and good..
except wouldn't the person have to be in isolation at time symptoms arrived to not spread ?

FORBOYSTOO--
that is the crux of the problem--
of course Mr. Duncan's fiancee and her son were in same house with him while he was initially ill and then significantly ill and neither one of them apparerently have developed symptoms...

I read one post on another site that said Duncan initially thought he had thyphoid--not Ebola...
and one post that said he did NOT go with the sick woman to the hospital In Liberia--and that was not how he picked up the infection...Supposedly he said he didn't know how he got it--
I have no idea how accurate that info is when so the media plastered the other story in our faces for days...
His fiancee has not made any other media comments since she has gone into seclusion--so guess there might be more than one reason to keep her isolated...

The ineptitude about the hospital was that the nurses treating Duncan were also treating OTHER patients--instead of being used solely for his care--
I bet you don't find nurses at Emory doing that with Ebola patients there...

I bet when all is said and done that money is the factor causing all the issues at TX Presbyterian---
1--the lack of training when the risk of actually dealing with an Ebola patient seems almost non-existant back in June or July when CDC sent out its notice---CDC notices were posted in the ER and given to ER staff--
NO training--no special reminders--no one in the communicable disease dept doing any pro-active assessment or equiment stocking--
and I bet by the end of Sept before Duncan made the news that NO hospital in Texas was doing anything pro-active, anything more than what this one did--
maybe other states/big metro areas with international airports might have been more proactive--but I wonder how many REALLY took the Ebola warnings seriously???

2--the refusal to keep him in hospital when he was running a 103 fever and obviously ill--He had no insurance, was foreign national and his fiancee doesn't appear to have lot of resources so she wasn't paying for the bill...
IF they had kept him then and managed to diagnose Ebola quickly--he still wouldn't have been in serious isolation from the get-go--
the second time until the diagnosis was CONFIRMED--the nurses weren't even in the more protective gear--even though that wasn't the Haz-Mat suits used in other facilities...

3--The fact that the hospital failed to understand/acknowledge that other workers could contact and spread the disease just shows that they didn't have a clue about how the disease works---

4--NOW supposedly the hospital has allowed so many workers--nurses, aides, clerks, whatever--- to be exposed and thus possible victims, they have had to send people home with pay to wait out the isolation periods--
thus they are short handed...and aren't really in a position to deal with any future Ebola patients...

These two nurses are much better candidates to be cured since they have been in treatment from the get go...
If Duncan had been afforded that level of care, he likely would have survived.

forboystoo, no. ebola is not a contagious disease, it's an infectious disease. You have to have some bodily fluid from an infected person pass through a mucous membrane of yours in order to get it. So you could sit next to a person who has ebola on an airplane, say, and who even has a fever, but you will not get it from that person. If the person vomits on you, THEN you might have a problem.

But Tibbrix, how can you explain how Kent Brantley, Nancy Writebol, and the NBC camera man contracted it? No one vomited on them. And if someone vomited on dr Brantley, he was wearing his suit, and feels he didn't contract it that way. This, to me,is the scary things about this virus...so many people cannot explain HOW they contracted it. Yes, mr Duncan's nephew reported to CNN that he was not in contact with the pregnant Ebola patient in Liberia..that was what the nephew said, at any rate, but CNN didn't seem to acknowledge that. And sadly, mr. Duncan is not alive to tell us his story. And I believe writebol and Brantley also assumed they had typhoid fever, initially...I guess they felt they were protected from Ebola so that was not their first thought when they started to feel bad.

I do not believe it will become an epidemic here. .but I understand the concerns....I feel like there are almost as many unknowns as there are facts, which leads to confusion.

Don't confuse not knowing the source of, say, Dr. Brantley getting it with knowing how it is transmitted from person to person. When he says he doesn't know how he got it, what he means is he can't think of the instance in which the virus was transmitted. But it WAS transmitted to him via some infected body fluid passing through some mucous membrane of his, his eyes, mouth nose…whatever. Because ebola is not a contagion, you cannot get it from sitting next to someone who has it, like you can, say, the flu or a cold.

Tibbrix~
Please believe me ~I don't intend the confrontation.

Is it not true that if the person was to sneeze or cough or wipe the nose and then touch the shared armrest I would be safe ???

There is too much to learn..
For you to say" If the person vomits on you, THEN you might have a problem." is misguided.

To date no one with Ebola has claimed to be vomited on.

Right, I agree, you have to touch * something * contaminated wth the virus to get it...and then I guess you then have to touch your face, eyes, etc, to get the virus into your system...all I know is that there is a group of well informed people that have now contracted the disease and cannot explain how that happened. I don't think I could get a cold or the flu from a person sitting next to me unless I handled something infected with their mucous, or if they sneezed or coughed and I inhaled those droplets. So I don't see them as being all that different, in the end. I was recently on a bus from NH to NYC, suffering terrible seasonal allergies. I blew my nose many times, and itched my eyes. At some point, I lowered the tray table...with my hand, which I was not able to wash. So yes, my germs are all over seat 7a.

Actually ebola is infectious (disease caused by an infecting agent, in this case a virus) and contagious (can be spread from person to person). It's just not as contagious as something like the flu or small pox.

For more info, I refer you to the link I posted above to the Ebola pathogen safety data sheet.

The parents of the cameraman who contracted ebola said he said he might have gotten it when they were washing down a car that had carried an ebola victim. They were spraying it with a bleach solution and it may have splattered on him. But specifically how he or the other victims got it may never be known.

This post was edited by AnnieDeighnaugh on Fri, Oct 17, 14 at 9:08

So lets stop calling it a "volunteer quarantine".
If you don't oblige and the CDC finds out it will become mandatory.
What ??
A nurse(tech) on a cruise is now in isolation for the last 2 days of her trip....no symptoms..just didn't self isolate.

forboy, I cannot believe anyone, let alone a nurse, would get on a cruise ship within two months of having treated a patient with ebola. There is absolutely no excuse for that, IMO. It's stupidity like that that causes a disease like ebola to spread.

Annie, nevermind malaria! WAY more contagious than ebola.

coll, there is a difference between catching a cold or the flu from someone and having ebola transmitted from person to person. it's a fine, one, though, seems to me, but I think I get it when the CDC explains the difference.

The LA Times had an interesting article about the protective gear, linked below. Apparently the most dangerous time is when the suit is being taken off. I truly don't know how people can tolerate the suits in Africa where no doubt they have no A/C and the climate is hot.

Here is a link that might be useful: protective gear

Tib, it doesn't matter if Snyderman didn't have any symptoms. She very well could have come down with a fever right there in front of the restaurant. Hence, stay HOME until the all clear sign.

Have you ever been in a public place and out of the blue you get sick? Like how the flu hits you just like that? I was in a mall once, feeling great. I was buying my dad a tie and as I was paying for it I threw up all over the place. LOL!! (Most embarrassing moment of my life.) I had just come down with the flu.

Who's to say Nancy couldn't have come down with a fever while at the restaurant? We cannot control when it hits us. That's why she was kindly asked to quarantine herself. The guy who went into the restaurant was supposed to be under voluntary quarantine also.

We cannot assume anything right now. If any of these professionals had a lick of common sense, the virus wouldn't be as threatening as it is now.

Heck, if Snyderman thought it okay for HER to get out and about, and she's a doctor, then why shouldn't the nurses feel the same way? One did, and now many many many people have been exposed.

The nurse should have stayed home. Common sense.

Now, a Dallas healthcare worker who handled Duncan's specimens is on a cruise showing symptoms and is quarantined.

From USA Today:
Belize's 7 News reports the Belize government refused a U.S. request Thursday to let the Dallas health care worker disembark in Belize so she could be flown home by air ambulance from a local airport.

Smart Belize government. Wish we would start getting some travel bans in place...

Oakley, with ebola it DOES matter if a person is presenting with symptoms. It is NOT transmittable when there are no symptoms. And a fever cannot transmit ebola.

If someone comes down with a fever while at a restaurant, they leave and go straight to a hospital before the transmittable symptoms start, namely vomiting, bleeding…bodily fluids coming out of the body.

Snyderman put no one at risk. Should she have stayed quarantined? Yes, as an extreme precaution. But she put no one in any danger whatsoever.

Now, the nurse who stupidly went on a cruise w/o any symptoms did a very reckless thing, in my opinion, because on a ship, you cannot get right out if symptoms do start appearing, and the logistics of getting someone on a cruise ship to a hospital/quarantined are very difficult, not to mention the problem someone mentioned above, that you could be in a foreign country and they can refuse to allow you on land.

It's hysteria to rage at Nancy Synderman because there was NO risk to anyone there.

The person on the cruise is not showing any symptoms. They are quarantined because they may have handled Duncan's lab samples.

Right, Coll. But that person NEVER should have gotten on a cruise ship during the gestation period, which is up to three weeks. And he/she is a health care professional! If you've come in contact with someone with ebola, esp. someone as sick as Thomas Duncan was…never mind knowing two of your coworkers contracted it…you don't get on a boat, of all things, until the gestation period is over and you then KNOW you don't have ebola.

That to me was a shockingly stupid thing to do.

Agree, the lack of common sense/ selfish behavior is upsetting. I don't believe Snyderman presented a serious risk, but I do feel that it was an arrogant thing to do in light of all that is going on. ...and she certainly should have known better. Oh hell, they all should know better!!

Well, I don't agree with the Snyderman criticism. She posed no risk to anyone. Had she gotten on a cruise ship or something similar, where you're basically trapped in an enclosed space for a long period of time, then she'd deserve criticism. Got to get through that incubation period before you start shutting yourself up for long periods of time with other people.

I don't think it serves anyone for people to lose their heads over this.

This whole thing makes me sick. Obama just appointed Ron Klain the Ebola Czar, but he doesn't even have a medical background. WTH? We should not be panicking but we sure as heck need to take this threat seriously. We don't need a political hack being the Ebola Czar we need someone with a medical background. This is just inexcusable.

She was in proximity of a guy that contracted Ebola. She and everyone on that tv crew agreed to self quarantine out an an abundance of caution, as the saying goes. Then she decided not to honor that decision, and I think it was arrogant to do so.

Energy should be directed to real threats, Coll, is all I'm saying. Ebola is a serious thing. Expending energy bashing someone who posed no risk to anyone is not a good use of energy.

Holly, the really bizarre thing is, we actually already have an Ebola czar. However it seems that no one is talking about this for some odd reason

http://reason.com/blog/2014/10/14/we-already-have-an-ebola-czar

Edited to add, not trying to politicize and would have chosen a more neutral link but it seems like only the conservative sites are talking about this agency and the missing HHS assistant secretary who is effectively an Ebola czar

Here is a link that might be useful: Where is the Ebola czar?

This post was edited by beaglesdoitbetter on Fri, Oct 17, 14 at 13:49

Expending energy bashing someone who should have been a role model for voluntary quarantine but instead violated that quarantine for no good reason is a good use of energy.

So the cruise ship with the healthcare worker is not being allowed to dock....so one person just ruined vacations for hundreds of others. They should have to reimburse them all.

If you want a REALLY GREAT read about Ebola, try this blog.

The author is a real epidemiologist

http://epidemiological.net/2014/10/13/ebola-crash-course-part-1/
http://epidemiological.net/2014/10/16/ebola-crash-course-part-2-history/

having two nurses come down with a virus that is transmitted only via direct contact with body fluids just doesn't add up. These nurses were in isolation gear

It is SOOOOOOOOOOO easy to slip up with isolation gear. The outside of your gear can be horribly contaminated.

Removing the gear is the weak point, because unless your technique is perfect, every time, you can contaminate yourself and your surroundings.

Something as habitual and reflexive as touching your face might be enough, because the Ebola virus needs so few particles to be infective to the average person.

Nonsense, Graywings. That's just self-righteousness. She was NO threat to anyone.

Excellent link, lazygardens.

I haven't lost my head over Snyderman but I am shaking it thinking someone out there honestly thinks she posed no risk at the time she and her driver left the house.

Everyone is adding body fluid to the the air we breathe, just by breathing, coughing, rubbing our nose, mouth, and eye's, then touching something.

So if Snyderman came down with a fever she would be immediately exposing people around her.

Would *you* feel comfortable being around Snyderman at that time? I sure wouldn't.

Err on the side of caution is what good doctors do.

DH and I are attending a medical symposium this week for internists and other medical specialities. During a lunch break the topic of Nancy Snyderman came up and the 3 physicians at my table who knew who she was felt that she should be censured by the state licensing board and fired by the network. They felt that she agreed to the quarantine and therefore had a professional and ethical obligation to honor it and as a physician had a duty to lead by example.

This post was edited by quilly on Fri, Oct 17, 14 at 13:54

I agree with those physicians, quilly. It's just too common for people to do things wrong and then think they can redeem themselves by apologizing. I'm so sick of that! She's a very foolish woman, lacking the integrity to do the right thing. When it comes to ebola, we need to err on the side of caution at all times.

Oakley, yes, I would have been perfectly fine to be around Nancy Snyderman at that time.

The fear has to be proportional to the threat. Nancy Snyderman was NO threat to anyone, ergo, no need fear or anxiety necessary.

Quilly, that is a different issue than whether she was a threat or not, which she was not. "setting an example" is a whole other thing. AS I said, yes, she SHOULD have maintained her voluntary quarantine. I am not arguing that she should not have done so. But both are true: She should have maintained it, AND she was no threat to anyone.

I have no problem with the "Ebola czar" not having a medical background. Managing the Ebola "crisis" has many parts to it, not just the medical aspect. Someone who can coordinate every aspect; education, transportation, medical, etc. is needed.

Keep in mind that none of the 4 people who were living with Mr. Duncan (when he was symptomatic) show signs of illness. In most cases symptoms show up within 8 to 12 days. The 21 day quarantine is an extra safe length of time.

Get your flu shot, vaccinate your kids, wash your hands with soap often, look both ways before you cross the street - chances are something else is going to get you.

ML

Exactly, ML.

Get your flu shot, vaccinate your kids, wash your hands with soap often, look both ways before you cross the street - chances are something else is going to get you.

I thought that this needed to be in bold print!

Agree with MR too. Don't get so wound up on the unlikely stuff that you forget the more common real threats.

Influenza, for example, can be spread during the 24 hours BEFORE you have many symptoms ... so that lunch with Bob in accounting the day before he calls in sick with the flu might have infected you.

Influenza has a The vaccination takes 10-14 days to get protective.

You can see the problem of waiting until people you know are sick. If you dash to Walgreens for the vaccine the day you hear Bob has the flu ... it may be too late. He may have infected you.

Beagle, thanks for the article. I had heard that we already had a person in place. That makes it even more curious as to why another so called Czar would be named. Maybe the more layers of bureaucracy makes it harder to see where the failures occur.

I think Snyderman acted very irresponsibly. She acted as though only mere mortals need to follow proper procedure. There is no excuse to think she is above following the imposed isolation. If others see a doctor not taking this seriously it certainly doesn't set a good example for the rest of us.

Assuming there is some degree of contagiousness at the point that one has developed a fever, consider this: no fever at 4pm, fever at the next check at 8 pm -- exactly at what point in time is one contagious? 7:59pm? 4:01pm? somewhere in between?

At what level of virus load is it possible to transmit the virus through secretions -- is it just before it is enough to trigger an immune response, an hour before, 6 hours before, 3 hours after? Not everyone mounts a fever (either at all or what is considered significant ie 100.4F) in response to infections, as most medical people know.

The answers may not be known yet (or ever -- medicine is still often a lot of educated guessing). But, because we don't know, and human bodies usually aren't like clockwork, Dr. Snyderman's actions were very ill-considered -- actually, not considered at all -- likewise the traveling hospital personnel.