I joined this club also and sure don’t regret it.
The following blog is written by a emergency room doctor who is comparing today’s Ebola epidemic to the Flu epidemic of 1918. It does make sense that since flu season is upon us that we are more than likely to get the flu than Ebola. Flu is contact and airborne, so that quick trip to Walmart could be the time that someone sneezed into their hands and then grabbed hold of that shopping cart. Disgusting isn’t it.
http://shirley-mclain.net/2013/01/12/are-you-sharing/ This link takes you to a previous blog I did a year or so ago on the flu called “Are You Shring”. Take a look at it. It might just save you a lot of misery. Shirley
I’ve been walking the earth for a half a century, so I’m sure I’ve picked up a bit along the way. I know the Gettysburg Address by heart. I can recite all the presidents. I can taste the difference between Diet Coke and Diet Pepsi, and I’m fairly certain I can tell you the starting lineup from the 1976 Cincinnati Reds. But if you ask me if I’m worried about Ebola, if our hospital is ready or if our nurses and staff are up to the challenge, chances are you will probably hear me say this:
“Hell if I know.”
I have been practicing emergency medicine for more than 20 years and I’ve seen close to 100,000 patients. I’ve written a few books, published some papers, lectured a bunch of times, pissed off about 10,000 soccer moms when I wrote an article telling them their kids weren’t playing the pros. I once even testified in front of a congressional sub-committee on hospital disaster preparedness. I’m still beating myself for at least not stealing a pen, but it was part of my duty as the physician director of mass casualty preparedness for our emergency department.
So you would think if anyone in the emergency department trenches would be versed as to how this Ebola scare will unfold, if it will spread, what to expect, how to diagnose, screen, protect and treat, then I suppose it would be me.
If an investigator for Joint Commissions or some other oversight agency, a member of the press or a committee trying to ensure CDC compliance were to pull me aside to spot check my Ebola acumen, they’d be satisfied with my answers and I’d leave them feeling like they had done due diligence as an administrator.
“Dr. Profeta, do we have enough protective stuff and does everyone know how to use it?”
“Are the screening plans in place?”
“Yeah, ya betcha.”
“Is the staff versed in transmission and spread of Ebola?”
“Has everyone read all the CDC and hospital communiqués regarding Ebola?”
“Have you practiced the drills in the ER in case we have someone show up with a possible exposure?”
“More times than Lois Lerner has hit her hard drive with a hammer.”
But if they were to ask me if there are any other issues they should be aware of, I’ll just stare with round blank eyes and keep my mouth shut until the right question is asked; the question they will pretend does not exist.
“Dr. Profeta, will they – the staff, you, your partners – show up? “
“That, I don’t know.”
Some years ago when I first started in practice, a very large hospital in our area was having trouble getting patients rapidly admitted from the ER to the floors. This resulted in a tremendous backlog of patients and extreme ER overcrowding. This naturally increased patient wait times and directly impacted the health of those coming to the ER. So, naturally, the hospital system formed a committee and hired consultants. They looked at every single variable: time to laboratory, time to X-ray, nursing changeover, bed request time and on and on and on. Do you know what they found? The roadblock in the movement of patients through this major medical system was housekeeping. Think about that. Housekeepers, traditionally the lowest paid and least-skilled division of employment of the hospital, were responsible for the movement and throughput of patients more than any other factor.
If the rooms on the floor were not cleaned fast enough, then no patients could move from the ER to the floor, and no patients from the waiting room to the ER. ER wait times rose and patient care suffered. Housekeepers handcuffed the entire system, and not because they were lazy. The regulations, protocols and procedures put into place to clean a room are so extensive that rapid room turnover was next to impossible with the current staffing model. That stuck with me. What is the rate-limiting step in a mass casualty scenario or massive patient influx that would handcuff us? Where will all the preparedness collapse? What is the leaking O-ring? What am I afraid will fail?
As I alluded to a bit earlier, I appeared before members of Congress who were investigating Midwest medical centers and regional hospital preparedness for a mass casualty event. The focus was on our readiness should a major earthquake hit the Midwest. The congressmen wanted to know if we had the capacity to mobilize our staff; they asked what assistance we needed. Toward the end of the discussion, they asked each of us what we were most afraid of. The responses were typical answers you would give to a member of Congress if you were seeking money (not having enough resources, not enough congressional or governmental support, not having enough staff or equipment or infrastructure, etc.)
When they got to me, asking what I worried about, I simply said: “The flu.”
Now, flash forward. I wonder if what I really meant to say was “Ebola.”
When it comes to our ER and our ability to provide the best care during the worst extremes, I have no doubt we can mobilize our hospital to care for hundreds and hundreds of seriously injured patients. We have modeled our Emergency Department response to a mass-casualty incident in much the way Israeli hospitals have structured their programs. (As a side note, Israel is light years ahead of us in terms of all mass casualty – chemical, biological, environmental, mad-made – preparedness.) Specifically, we model our plan after Western Galilee hospital on the border of Israel and Lebanon. This is a large, major, modern-day medical center under constant threat from Hezbollah rockets from Lebanon. They train and drill with a level of involvement, passion and commitment that exceeds anything we can muster.
The staff at my hospital in Indianapolis, however, has bought into it and I truly believe that there is no ER in Indiana, and few in the Midwest, that have a better plan in place. We also gained a better understanding of the type of injuries we would see in each scenario. More specifically, we wanted to know from a pure number standpoint how many patients would have to go to the operating room the minute they hit the door, how many would need to be on ventilators and how many would need emergent life-saving intervention. Fortunately, and not so fortunately, the proliferation of research in this area has provided plenty of hard data well documented in the literature. Ultimately, all things being equal, the data seems to indicate a suicide type bomb loaded with ball bearings or other projectiles placed in a crowded area will result in the largest number of patients requiring immediate, emergent and life-saving intervention. While a disaster like a major earthquake will result in far more fatalities, far less people will require absolute immediate operative or life-saving intervention. All we really need to know is, what type of event, how many patients, and it’s pretty easy to calculate what to expect from an acuity standpoint. In the ER, it isn’t the total number of patients that concerns us, it’s the number we get that will die if not treated in minutes or a few hours. The rest we have no problem letting wait.
Ultimately, though, what I am getting at is that the trauma from a major incident like an earthquake or terrorist attack is very predictable. All you really need to know is the type of event and the numbers and you almost immediately have a pretty good idea of what to expect.
But a real bad flu?
There is no way you can prepare for it. The goal should be to protect your hospital from it.
We have seen influenza pandemics before, the most notable being the Spanish flu of 1918. Researchers estimate between 20 and 100 million peopled died from this strain of flu. What was even more concerning was the number of deaths that occurred in previously healthy people. Each year in the United States, about 30,000-40,000 deaths and 200,0000 hospitalizations can be attributed in part to influenza. Most deaths are in the elderly with pre-existing serious health problems. The Spanish flu of 1918 was different. It killed the healthy, able bodied. It unleashed an incredible degree of viral savagery with an infection rate of nearly 50 percent. It was a biological holocaust.
Doctors and nurses treat flu patients lying on cots and in outdoor tents at a hospital camp during the influenza epidemic of 1918. (Photo: Hulton Archive/Getty Images)
Thus my biggest fear has always been a strain of flu that is highly contagious with a high mortality rate. The Spanish-flu mortality rate of 1918 was 2 to 5 percent. Ebola has a 20 to 90 percent mortality rate, but it fortunately is not quite as contagious as Influenza. However, I still keep going back to flu and envisioning an epidemic of the Spanish type that will quickly fill all our inpatient beds, every ICU bed, every ventilator, every outpatient bed, every cot, gurney and chair in the ER and in all the waiting rooms. I’m afraid that a flu virus this aggressive will bring five dying flu victims to our ER each day and dozens more with a real possibility of dying.
This would occur on top of a department that is always operating at capacity and drowning in documentation and electronic medical record bureaucracy. After 30 days in our ER, nearly 150 people will have died, providers will be physically and mentally spent and morale will be at below-despair levels. Multiply it by 20 or so other hospitals in the area and now we are talking about 3,000 members of our community dead in only a single month. The obituary pages of the local paper will be thicker than the advertising section the day after Thanksgiving. Expand that number statewide and nationwide and the numbers become so immense they aren’t even real.
Now imagine a realistic scenario in which the flu vaccine only provides immunity to 50 percent of the recipients. That means that half of our ER staff who are seeing all these patients will have little protection, outside of gowns, masks, and gloves, against a virus that is spread primarily though coughing, sneezing and saliva. Simply put, some of us in the trenches in damn near every ER in America will almost certainly die. It could be me, it could be any one of my partners, colleagues and co-workers and it could be one of our children or a spouse who gets infected when one of us comes home thinking the headache and fatigue they are feeling is simply exhaustion from the workload of the day. Can you picture it?
Now imagine that huge numbers of hospital staff – from doctors to housekeepers, from food services to registration, from security and parking to transportation will decide not show up. They will call in sick or simply just say: “No, I’m not coming to work today.” In just a few days, human waste, debris, soiled linens, the sick, the dying and the bodies will pile up. We will be overwhelmed and unable to offer much in the way of assistance because the labor-intensive protocols that allow us to safely care for even one patient are just too exhausting. These procedures are barely repeatable more than once or twice of day, and fraught with so many steps and potential for mistake that it becomes too physically and emotionally taxing for the staff to do … so they simply wont show up.
And I am not sure I will, either.
I love emergency medicine. I love helping people and saving lives and I think I’m pretty good at it, but I am also a person and I have a wife and three children that I love and want to see grow up. I also am keenly aware that not a damn thing I do will have any real impact on the survivability of a patient with either the Spanish flu or Ebola. Fluids, rest and prayer is about all there is to offer. There is an old adage that says a hospital is no place for a sick person. I think whoever first said that had Spanish flu and Ebola in mind.
So we drill and we prepare and we post placards and do screening but no one is asking why in the hell are they coming to us in the first place? Fluids and rest can be provided anywhere: an empty warehouse or a huge tent in the middle of farmland. Why would we not just take the care to them in the form of special traveling Ebola-mobiles that triage and treat the patients at home? Why can we deliver the mail, pickup the garbage and recyclables at damn near every house in America, but we can’t pull up a retrofitted UPS van, drop off a mid-level provider in a hazmat gown, let them do an assessment, draw some blood, drop off cans of rehydrating formula to their doors, clean linen, biohazard bags, gowns and gloves for family members, slap a warning sticker on the front door, tell them you will stop by tomorrow and move on to some other location? I know I sound crass, perhaps like I don’t really have sympathy for these very ill patients. This could not be further from the truth. I’m just kind of angry. I know there is a better way than risking the infrastructure of a medical center for the sake of a few patients that will either do OK at home with simple supportive care or die no matter what care I provide. We’ve had years to prepare for this, we’ve hung all our hopes on a vaccine and not nearly enough thought on containment should a vaccine fail.
Today’s Ebola is tomorrow’s Spanish flu. We’ve had nearly a hundred years to get ready and the best we can come up with is plastic suits, double gloves, respirators, and masks. The battleground of this problem can’t be in the hospital. It is unwinnable in our emergency rooms.
I think I might just call in sick.
Dr. Louis M. Profeta is an emergency physician practicing in Indianapolis. He is the author of the critically acclaimed book, The Patient in Room Nine Says He’s God.
Hey girl, I enjoyed reading this very truthful blog. I know all about that limited income. I hate the PR work that goes along with my book because I don’t have time to write at all. I’m either on the social sites are looking for someone to do reviews for the book. What I hate is the sites that do reviews but will only do traditionally published books. There are a lot of excellent books they miss out on because of their short sightedness. Oh well enough of my soapbox. Great blog and I have reblogged it. Have a blessed afternoon.
This is another article on Ebola. These articles are to educate and not cause unnecessary fear. Being forewarned is being forearmed. Have a blessed day. Shirley
ebola biohazard suit hose
Physician Thomas Klotzkowski cleans Florian Steiner, a doctor for tropical medicine, in a disinfection chamber at the quarantine station for patients with infectious diseases at the Charite hospital in Berlin.
The Ebola virus is uniquely terrible for many reasons, but it doesn’t actually kill you. Your own immune system does.
In its struggle to beat back the virus, your immune system’s reaction ravages the rest of your body, leaving your blood vessels weak and leaky.
Soon, blood and plasma start pushing through, sometimes coming out of your pores and every orifice.
But long before the body begins to fail — around the time Ebola first enters the blood — the virus starts tripping up our defenses.
Here’s how it kills, how it spreads, and how it can be treated. In every step of the way, this deadly virus is uniquely terrible.
The Ebola virus. So small. So deadly.
Ebola is a filovirus, a type of virus made from a tiny string of proteins that coat a single strand of genetic material. Particles of the virus live in an infected person’s blood, saliva, mucous, sweat, and vomit.
When someone is at the height of the illness (typically after five or more days), one-fifth of a teaspoon of that person’s blood can carry 10 billion viral Ebola particles, The New York Times reports.
An untreated HIV patient, by comparison, has just 50,000 to 100,000 particles in the same amount of blood; someone with untreated hepatitis C has between 5 million and 20 million.
If those particles find an entry point, like a cut or scrape, or if a person touches his or her nose, mouth, or eyes with fluids that contain them, they get to work quickly.
Once inside the bloodstream, the virus targets a compound called interferon. Interferon, named for its role in “interfering” with the virus’ survival process, alerts the rest of the immune system to the presence of a foreign invader. Normally, interferon would deliver its warning message straight to the cell’s command center via a special “emergency access lane.”
Ebola is too smart for that old trick.
The virus hijacks the delivery process — preventing the immune system from organizing a coordinated attack — by attaching a bulky protein to the messenger. In its misshapen form, the messenger can’t enter the cell. The immune system remains unaware of the problem, and the virus gets free range to attack and destroy the rest of the body.
This is when Ebola goes on a replication rampage. Once the virus starts growing, few things can stop it.
The virus starts infecting organs, killing the cells inside and causing them to burst. All of their viral content pours into the blood. By this time, the immune system begins responding to the crisis in turbo mode, but it’s far too late. Rather than destroying the virus, our defenses simply rip our own bodies to The World Health Organization has said the virus seems to kill about 70% of people infected, though it’s hard to know the true numbers while the outbreak is still in progress.
How It Spreads
ebola patient escaped liberia
Ebola doesn’t need to be airborne to cause an epidemic. Anyone who touches a sick patient is at risk.
Although Ebola spreads less easily than a cold, because it isn’t airborne, the Ebola virus is far more persistent.
Like cold germs, Ebola virus particles survive on dry surfaces, like doorknobs and countertops, for several hours. But unlike a cold virus, which primarily infects the respiratory tract, Ebola can also live in bodily fluids like blood and saliva for several days at room temperature.
Doctors have found Ebola in the semen of men who have survived the virus up to three months after they recover.
It’s important to remember that someone with Ebola isn’t contagious until he or she starts showing symptoms. This happens when enough of a person’s cells have been overtaken by the virus, a process that scientists say appears to require a hefty load of viral particles in the body.
There’s also the prospect of Ebola mutating into something more deadly. Peter Jahrling, one of the head scientists at the National Institute of Allergy and Infectious Diseases, thinks the virus could already be changing into something more dangerous, Vox reports.
In recent tests with Ebola patients in Liberia, Jahrling has noticed that the infected seem to have more of the virus in their blood, which could presumably make them more contagious.
And even worse, it preys on our human need to touch and care for the sick, which is why much of its spread is to caregivers and healthcare workers.
“The mechanism Ebola exploits is far more insidious,” as Benjamin Hale wrote in Slate. “This virus preys on care and love, piggybacking on the deepest, most distinctively human virtues.”
That’s why the virus strikes children, their parents, families, and communities. All it takes is one small slipup, one uncalculated act of humanity, and the disease spreads even further.
How It Is Treated
Bellevue Hospital Workers Ebola Prep
Ebola treatment is dangerous — and expensive.
It’s tough to believe that anyone could survive Ebola, given its quick and violent progression. But two Americans did, and thousands of people in Guinea, Liberia, and Sierra Leone have as well.
The virus’ quick progression makes comprehensive treatment in a well-equipped facility key for raising one’s chances of survival. If doctors can keep a person strong enough for long enough, that person’s immune system can eventually clear the virus on its own.
In Atlanta, two Americans were nursed back to health with a combination of experimental drugs and traditional treatment. By keeping their patients’ organs working with intravenous fluids (to replenish the body with the fluids it is quickly losing), ventilators (to keep the lungs pumping oxygen throughout the body), and drugs to keep blood pressure from dipping dangerously low, they gave them the best chance of survival.
That sort of treatment is pricey, though.
The bill for the average Ebola patient treated in the US is a lofty $1,000 per hour. In West Africa, where that sort of money isn’t available, most patients simply go home to die.
To date, no federally approved vaccine or medicine for Ebola exists.
Can You Get Ebola from a Sneeze?
Do you have of fear of getting Ebola? I’m not talking about panic just the thought that it could happen. There is a lot known about the disease but there is also unknowns. I am thinking about it because my husband flies frequently to Washington DC and Dallas. I know on those flights he is with people from all over the world. He was in the airport on the day the man who eventually died was there.
I know if he contracts the disease, I will also. I’m not so much afraid for myself as I am for my children and their families. I live close to my daughter and I am of the age that if I get sick she comes to me to help. What do I do from now on just tell her to stay away. I know if it’s not flu like symptoms then there won’t be an issue. I just have to leave this in God’s hands.
I think it is important for everyone to stay aware of what is happening. Knowledge about the disease will keep down panic, no matter what is happening in the world.
While experts argue over whether Ebola will mutate and become airborne, questions linger about what exactly airborne means in the first place.
For example, could you get Ebola from a sneeze? And, if so, would that mean it was airborne?
“With airborne illnesses, like influenza or tuberculosis, you can easily get sick by inhaling tiny pathogenic particles floating around in the air,” according to NPR, based on interviews with two virologists, Alan Schmaljohn at the University of Maryland School of Medicine, and Jean-Paul Gonzalez at Metabiota.
That’s not the case with Ebola, which requires large droplets to transfer.
Could Ebola Become Airborne?
“That means an Ebola-infected person would likely have to cough or sneeze up blood or other bodily fluids directly in your face for you to catch the virus,” Schmaljohn told NPR. “If that drop of blood doesn’t land on your face, it will just fall to the ground. It won’t be swimming in the air, waiting to be breathed in by an unsuspecting passerby.”
So while it’s theoretically possible for someone with Ebola to sneeze and emit a large drop of saliva into someone’s eye, it’s so unlikely that health officials don’t waste much time parsing out those hypothetical scenarios, Schmaljohn said.
“WHO is not aware of any studies that actually document this mode of transmission. On the contrary, good quality studies from previous Ebola outbreaks show that all cases were infected by direct close contact with symptomatic patients,” the World Health Organization says.
Quick Ebola Test, Not Quarantine, Could Be Best Defense
Doctors tend to have a different definition of “airborne” than the general public, Reuters points out. To doctors, it means that the germs are so tiny that they can float in the air for long periods, even when dry. They can infect people from a distance because they make their way deep into lungs when inhaled. Chickenpox, measles and tuberculosis are examples of airborne diseases.
A more appropriate term for Ebola, then, may be “droplet-borne.”
With Ebola, “when someone coughs, sneezes or … vomits, he releases a spray of secretions into the air,” according to Reuters. “This makes the infection droplet-borne. Droplet-borne germs can travel in these secretions to infect someone a few feet away, often through the eyes, nose or mouth. This may not seem like an important difference, but it has a big impact on how easily a germ spreads.”
And the good news? Droplet-borne diseases are much harder to spread than airborne illnesses.
BY SHEILA M. ELDRED
Congrats on your blog award Carole. I wish you the best and a blessed evening.
I think anything on how to use and understand Linkedin is beneficial to everyone. Thanks for looking and drop by and say hello to my friend who originally blogged this on his site. Have a blessed day Shirley
I think all of us Authors have dreams of making it and getting rich with our fabulous book. This is the other side of the coin. You know that part that tries to break the dream. For me, I will continue to think and dream that I will be the next Diane Gabledon or J.K. Rowling. A girl can dream, can’t she?
What fun this was. I love being a member of this book club. Besides being fun they are so supportive of their authors. Check them out if your a writer. Have a blessed day