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Xandu posted:The last isolation unit I was in at a hospital had a locked door, negative (or maybe positive, I can't remember) air flow, and nobody entered without wearing a mask and gloves (while also making sure I was wearing a mask). Negative air flow for the room, positive for any bio safety suits worn in the room . You always want air flowing into the dangerous area, not outside or into your suit.
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Sep 10, 2014 04:49
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Xandu posted:The last isolation unit I was in at a hospital had a locked door, negative (or maybe positive, I can't remember) air flow, and nobody entered without wearing a mask and gloves (while also making sure I was wearing a mask). And that's just at an average hospital, the places these people are being evacuated to tend to have special wings to make sure there's absolutely no spread. Was it strictly for foreigners? I'd read that it was a 25-bed facility to service HCWs and hadn't seen any reported restrictions to foreign HCWs. E: I'd imagine it'll be a completely self-contained facility, with grounds for security, HCWs, a center for power generation, and (hopefully) some form of central air conditioning. My Imaginary GF fucked around with this message at 05:15 on Sep 10, 2014 |
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Sep 10, 2014 05:13
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According to Buzzfeed, yes. At 25 beds, I imagine that's largely a capacity issue. http://www.buzzfeed.com/jinamoore/us-military-builds-ebola-hospital-in-liberia-mdas#1vgfs46
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Sep 10, 2014 05:16
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Going through those sitreps for Liberia, the past seven days have basically the same totals as the past seven days in Sierra Leone. This seems odd as we keep hearing about Liberia being a disaster but nothing like that from SL.
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Sep 10, 2014 05:16
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Torpor posted:I really don't think this type of thing is necessarily such a great idea. US Hospitals are not good at stopping contagious pathogens. We deal with Meningitis all of the time, and that's basically the same vector.
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Sep 10, 2014 06:45
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Zeroisanumber posted:We deal with Meningitis all of the time, and that's basically the same vector. Bushmeat causes Meningitis?
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Sep 10, 2014 06:53
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Rygar201 posted:Bushmeat causes Meningitis? The eating of fully cooked bush-meat has a fairly low chance of viral spread, when compared to the chance an individual acquires a blood-borne pathogen during the butchering process while in the bush. Its not very pretty and is quite bloody.
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Sep 10, 2014 07:01
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Rygar201 posted:Bushmeat causes Meningitis? Hospitals don't tend to have wild animals running around to kill for food.
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Sep 10, 2014 07:03
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Xandu posted:According to Buzzfeed, yes. At 25 beds, I imagine that's largely a capacity issue. Yeah the fact that its only 1 treatment center and its a small one at that is really bad. The UK at least is setting up a 72 man one (60 normal patients 12 HCW), which once fully operational they will hand over to the Red Cross Staff and then probably go and build another 72 man center, and maybe keep going on this cycle after that. They are also doing it in Sierra Leona where a center of this capacity could make a massive difference.
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Sep 10, 2014 07:04
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ukle posted:The UK at least is setting up a 72 man one (60 normal patients 12 HCW), which once fully operational they will hand over to the Red Cross Staff and then probably go and build another 72 man center, and maybe keep going on this cycle after that. They are also doing it in Sierra Leona where a center of this capacity could make a massive difference. Does HCW have a meaning besides "health care worker" that I'm not aware of?
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Sep 10, 2014 07:14
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Grundulum posted:Does HCW have a meaning besides "health care worker" that I'm not aware of?
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Sep 10, 2014 07:29
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Ravenfood posted:I read that as "a facility for 60 normal patients with 12 additional beds reserved for HCWs that get exposed" Yes that's how it was meant, I should have been a bit more clearer.
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Sep 10, 2014 07:43
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One day update by the WHO says that from the 5th to the 6th more than 300 cases and nearly 200 deaths were recorded! http://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa#cite_ref-Ebola_Outbreak_total_1-4 http://apps.who.int/iris/bitstream/10665/132834/1/roadmapupdate8sept14_eng.pdf?ua=1 Someone earlier in the thread noted that as of Sept. 5th "the cases had doubled from what they were 22 days ago, which were double what they were 30 days before that, which were double what they were 35 days before that. Periodic doubling would indicate exponential growth, but the rate of doubling is itself increasing..." and I will note that at the rate of 300+ cases a day as seen on the sixth, this period of doubling will occur in just 13 days, even with no further acceleration of transmission. It seems clear that this epidemic has long past reached the point of no return in West Africa. The time when outside intervention could contain things has passed, we've given far too little, far to late. Hundreds of Thousands of people in Liberia, and hundreds of thousands more in both Sierra Leon and Guinea will die. Lets pray that it does not similarly spread out of control elsewhere in West and Central Africa, but I'm not seeing much hope.
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Sep 10, 2014 07:48
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Charlz Guybon posted:One day update by the WHO says that from the 5th to the 6th more than 300 cases and nearly 200 deaths were recorded! Honestly if the death toll in almost any of those countries passes the 100,000 mark due to Ebola the country will probably be in full scale Civil War / anarchy so the death toll will be higher. This of course will mean the inevitable will happen and infected spread it to neighboring countries fleeing the fighting. Hell in the case of Liberia and Sierra Leone it looks like its only a few weeks away from anarchy anyway, given how bad the food situation is.
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Sep 10, 2014 08:06
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Charlz Guybon posted:One day update by the WHO says that from the 5th to the 6th more than 300 cases and nearly 200 deaths were recorded! I was looking at the data from Liberia's SitRep 114 and 115. It appears a treatment unit [ELWA-II] hasn't reported or been shutdown temporarily. So far I've got ELWA-I, ELWA-II, and ELWA-III all being on the ELWA Hospital Compound, and which were planned to have a 400-bed ISU set up by Sept. 3rd. Unfortunately, that hasn't happened, and it appears ELWA-II has been a source for three HCW infections on 7-Sept-14, per SitRep115. Given the previous report about taxis and transit from West Point to ELWA....that doesn't sound good. I think it may be time to start a definition of terms in the op. So far I've got: HCW: Doctors, nurses, burial teams, epidemiologists; those at highest risk for ebola infection and who require the greatest available PPE Support Staff: Security guards, cleaners, laundry staff, ambulance drivers/lorry deliverers, contact tracing teams ISU: Isolation unit. Unsure the standards in West African healthcare setting on what qualifies as an ISU. ETU: Ebola Treatment/Transfer Unit, temporary holding location until an individual can be placed in an ISU bed. ELWA: American missionary group with a presence in Liberia, operates a hospital, three ISU treatment centers, a school, and a radio station. More info at http://simusa.org/latest-news/4312/elwa_ebola_update or http://www.elwaministries.com PPE: Protectice equipment designed to provide a barrier between your mucus9 membranes and potential ebolavirus infection. Droplet: Airborne: N95: Respirator for contained breathing to avoid droplet transmission 400 and 250 Microns: Island Clinics: MSF/WHO/USMIL are constructing a treatment center on an island in Liberia with an enlargened capacity ISOS: international sos, reputable non-profit that coalates daily updates by each nation impacted and also maintains a list of suspected and ruled out cases, founs at-- https://www.internationalsos.com/ebola/index.cfm?content_id=407&language_id=ENG Reservoir: Animal host for ebolavirus that has been documented in cross-species transmission Vector: Nosocomial: Through healthcare setting CFR: Case fatality rate SEIRS: IDEAS: R0: number of additional cases which one infectious case is likely to generate before death or recoveryn; estimated rate varies for this outbreak Discount Factor: i:
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Sep 10, 2014 08:29
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ukle posted:Honestly if the death toll in almost any of those countries passes the 100,000 mark due to Ebola the country will probably be in full scale Civil War / anarchy so the death toll will be higher. This of course will mean the inevitable will happen and infected spread it to neighboring countries fleeing the fighting. It doesn't even need to be the death toll that wrecks these countries. I'm honestly a bit more worried about the economic paralysis and potential famine that might ensue due to quarantine procedures coupled with the inability to transport needed supplies to where they are most needed.
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Sep 10, 2014 08:45
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My Imaginary GF posted:I was looking at the data from Liberia's SitRep 114 and 115. It appears a treatment unit [ELWA-II] hasn't reported or been shutdown temporarily. I can help with some definitions. Droplet: Virus suspended in mucus from cough or sneeze Airborne: A virus that can travel by air current through aerosols or particles in the air itself. The main difference between this and droplet transmission is the virus's ability to remain in the air after the droplets evaporate. A virus is considered airborne if it can infect someone who enters a room after the sick person already left. 400 and 250 Microns: The average range of Ebolavirus aerosol droplet size. Only droplets smaller than 60 microns can stay in the air. Vector: Arthropod that acts as an intermediate for a pathogen between the pathogen and another animal. Ebola Roulette fucked around with this message at 15:31 on Sep 10, 2014 |
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Sep 10, 2014 15:19
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Pillowpants posted:Going through those sitreps for Liberia, the past seven days have basically the same totals as the past seven days in Sierra Leone. Sierra Leone was showing good signs of control up until the end of August. There's models that account for spread and ability of control. Sierra Leona and Guinea were following those models until the end of August, and then number of infections in both countries have started to pick up since then. Also, droplet transmission can be what some people not in medicine consider "airborne." There's a case report of an Ebola patient undergoing surgery and despite sterile technique being followed, most of the people in the operating room were infected from blood droplets in the air. Lote fucked around with this message at 16:34 on Sep 10, 2014 |
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Sep 10, 2014 16:29
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My Imaginary GF posted:If I remember correctly, you teach in Benin, right? I don't suppose you have PM or have another way to get in touch -- I work on Ugandan educational development and would be interested in picking your ear, except its a bit outside the bounds of this thread. I did teach in benin but my contract finished so I am now in the states again. But you can email me at usernameSA at Gmail.
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Sep 10, 2014 16:41
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My Imaginary GF posted:The eating of fully cooked bush-meat has a fairly low chance of viral spread, when compared to the chance an individual acquires a blood-borne pathogen during the butchering process while in the bush. Its not very pretty and is quite bloody. There is a Vice video on youtube about bush meat and ebola that has a couple scenes of people slicing their hands while butchering and preparing the meat: https://www.youtube.com/watch?v=XasTcDsDfMg
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Sep 10, 2014 17:48
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Gah http://m.us.wsj.com/articles/BL-DISPATCHB-4119 "In the weeks before her death, as Ebola was stalking the tin-roof homes of rural Liberia, her friends and family had come to worry that she was growing closer to God in a way that jeopardized her stay on Earth, they said. They begged her to stop touching the sick. To each of them she replied, “I know my God will protect me,” Mrs. Wahid recalled." Almost as bad as the loving hospital turning her away with painkillers. Is there a recommended way to deal with that though, if there aren't enough beds to spare? Xandu fucked around with this message at 21:57 on Sep 10, 2014 |
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Sep 10, 2014 21:55
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Just watched the new Frontline piece on Ebola in Sierra Leone - great doc as always, but man, that was tough  Time to bump up my monthly donations to MSF, that's for sure.
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Sep 10, 2014 22:37
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Xandu posted:Almost as bad as the loving hospital turning her away with painkillers. Is there a recommended way to deal with that though, if there aren't enough beds to spare? Not really. You can tell the family to isolate the patient and not to touch them, but chances are that you're telling them to go home and die, and to infect their relatives along the way.
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Sep 10, 2014 22:42
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There's no way to have like a separate quarantine area where you don't actually treat them? I imagine the patient turnover is reasonably high in an ebola clinic.
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Sep 10, 2014 22:48
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Xandu posted:There's no way to have like a separate quarantine area where you don't actually treat them? I imagine the patient turnover is reasonably high in an ebola clinic. Sure, they could pitch big tents or something, but I don't know how much good it would do if there weren't any supplies to treat them or medical workers to provide the treatments. I guess if I had Ebola and there was no medical help available, I'd choose to lie down and die there rather than taking the chance of infecting my family. It's grim as gently caress, but without supplies and skilled workers you're pretty much down to handing the patient a lucky rabbit's foot and hoping for the best.
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Sep 10, 2014 22:55
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Xandu posted:There's no way to have like a separate quarantine area where you don't actually treat them? I imagine the patient turnover is reasonably high in an ebola clinic. Unfortunately, thats essentially what ELWA facilities are being treated as. How do you transport the individual? How do you make sure they don't flee the transport and return home, or, worse, spread rumors that you dumped them to die because of Malaria/a spell they cast on you, and the community must expel them to be safe [with customary property laws, in that if you are male you acquire all property of the individuals you name who flee to escape social reprocussions/ebola]? In Liberia, USMIL is constructing a large-scale camp to concentrate and contain potential ebola cases on an island. Phrase that incorrectly, permeate through the rumor networks, and you've got Americans constructing concentration camps to kill all the poor (insert primary identity group) Liberians so their Firestone and Arcer-Mital can take our homeland's riches. E: Zeroisanumber posted:It's grim as gently caress, but without supplies and skilled workers you're pretty much down to handing the patient a lucky rabbit's foot and hoping for the best. I'd love a medical opinion on one of the documents I linked several days ago with current medical supplies broken down by medication. I'm wondering, assuming a 7 or 10 day supply is given to an individual, how many individuals can receive the pain pills currently in stock? My Imaginary GF fucked around with this message at 23:04 on Sep 10, 2014 |
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Sep 10, 2014 23:00
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My Imaginary GF posted:
Right, I get that. But this particular scenario is just absurd. People seeking out help for hours, only to end up at home, having potentially infected half a dozen people on the way there and back. At least they've started handing out gloves and bleach to the people they turn away in some cases. http://online.wsj.com/articles/deadly-disappointment-awaits-at-ebola-clinics-due-to-lack-of-space-1410137713 posted:The shortage is so dire that ambulances have picked up people raging with the symptoms of Ebola, driven them around for hours, then dropped them back at home, medical workers say.
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Sep 10, 2014 23:04
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Xandu posted:There's no way to have like a separate quarantine area where you don't actually treat them? I imagine the patient turnover is reasonably high in an ebola clinic. If you're not going to treat them, how do you convince patients to stay in the quarantine area? It's hard to rationally convince terminally sick, suffering people with high fever to just lie down and await deaths. Threats are not going to work with someone who is going to die anyway. Using force is very risky, given that their blood and sweat are full of viral particles.
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Sep 10, 2014 23:08
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Xandu posted:Right, I get that. But this particular scenario is just absurd. People seeking out help for hours, only to end up at home, having potentially infected half a dozen people on the way there and back. At least they've started handing out gloves and bleach to the people they turn away in some cases. Yeah, I've read and heard similar  I'm going to bet that, by the time this epidemic burns out, taxis/autos are identified as an amplification method. Taxis don't usually have a barrier between the operator and passengers in Liberia, at least none that I've ever heard of so I may be wrong. In which case, gloves/bleach won't prevent the high-risk infection from droplet exposure within 1-meter. I was attempting to geolocate the treatment centers last night and calculate their distance measured in time along roads with slightly reduced from average traffic, and from locations from which I've been seeing reports of temporary ETUs/sanitized homes. It was a bit too difficult to begin without accurate definitions of terms and geolocating the treatment centers first.
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Sep 10, 2014 23:12
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I don't get how so many health care workers are getting infected with a virus that is transmitted by body fluids. I know that protective supplies are low but you'd think that gloves, a face mask and goggles would be enough to keep the whatever fluids might fly your way. Also surprising to see that so many western doctors as well as accomplished African doctors are getting infected. I can undertstand how underequipped nurses get infected but how are these all star doctors getting infected as well? Are these hospitals covered in blood and vomit? I get that everyone else gets it through preparing/eating bushmeat and unsanitary funeral practices but I'm having a hard time wrapping my head around all the HCW infections.
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Sep 11, 2014 00:49
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laxbro posted:I don't get how so many health care workers are getting infected with a virus that is transmitted by body fluids. I know that protective supplies are low but you'd think that gloves, a face mask and goggles would be enough to keep the whatever fluids might fly your way. Imagine you're sweating, absolutely drenched in sweat from the tropical heat. You want to get out of your isolation suit, quickly as you can, so maybe a little bit of blood or vomit ends up on your hand as you remove the gloves, manages to get around your hand washing. And then you wipe the sweat off your face with your hand, as one does. two weeks or so later you come down with a bit of a fever... like that, or something equally inconsequential. every day. The PPE is hard to take off properly in the best of circumstances when lightly contaminated, much less after spending 7x12hr shifts on a severely undermanned ebola ward. These people are straight up heroes.
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Sep 11, 2014 01:59
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Usually people mean blood and semen when they refer to transmission via bodily fluids. For some reason I'm under the impression that ebola is transmissible in sweat and saliva. Is this correct?
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Sep 11, 2014 02:54
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Spazzle posted:Usually people mean blood and semen when they refer to transmission via bodily fluids. For some reason I'm under the impression that ebola is transmissible in sweat and saliva. Is this correct? Yes. Ebola is transmittable through just about every bodily fluid, I think, whereas HIV is mostly just through blood/semen.
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Sep 11, 2014 02:57
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Spazzle posted:Usually people mean blood and semen when they refer to transmission via bodily fluids. For some reason I'm under the impression that ebola is transmissible in sweat and saliva. Is this correct? from the CDC:  Also similar to cholera and polio it can be spread through contaminated sewage
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Sep 11, 2014 02:58
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Xandu posted:Yes. Ebola is transmittable through just about every bodily fluid, I think, whereas HIV is mostly just through blood/semen. And droplets. Contact within one meter is considered high-risk for contamination by ECDC. One of the emerging trends that I'm seeing reported are symptoms of caughing during infectious stages. E: my understanding if HIV is it varies by which virus and viral load; primarily blood and semen due to their concentrated viral loads, however, direct transmission via other fluids are theoretically possible, if very not likely to occur. When its said that HIV transmission through saliva alone has no risk, what it means is that anything short of injecting someone's saliva through syringe directly to your heart poses no risk. At least, thats my understanding of the highest potential viral load transmission of HIV through saliva direct into the blood stream. Its not impossible for your body to fight off HIV, especially at very, very low viral loads and of HIV-2 type. HIV can also be shed through vaginal fluids. HIV's great weakness is that it doesn't survive well outside a host. My Imaginary GF fucked around with this message at 03:23 on Sep 11, 2014 |
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Sep 11, 2014 03:12
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laxbro posted:I don't get how so many health care workers are getting infected with a virus that is transmitted by body fluids. I know that protective supplies are low but you'd think that gloves, a face mask and goggles would be enough to keep the whatever fluids might fly your way. For HCWs actually treating EVD patients it's tough as hell. Working conditions will be an outdoor tent, 80+ degrees, and you're covered head to toe with Tyvek. I heard in an interview with a MSF worker they were doing 45 minutes on, 1 hour off just to keep from becoming dangerously dehydrated... and that's before ELWA was opening up centers only to have them saturated within hours. It's an environment conducive to mistakes, to put it mildly. But also consider: Dr. Sacra, the latest American to be evacuated back, caught Ebola while delivering babies - he wasn't treating (known) EVD patients. So there's an underlying risk, possibly from patients lying and doctors not taking full precautions, poor isolation practices... who knows. Whatever it is it's only going to get way worse. My Imaginary GF posted:And droplets. Contact within one meter is considered high-risk for contamination by ECDC. That's really interesting. CDC considers contact within one meter without PPE to be low-risk. http://www.cdc.gov/vhf/ebola/hcp/case-definition.html And WHO doesn't differentiate between risk levels for their case contacts, and doesn't consider droplet contact as a risk at all. http://www.who.int/csr/resources/publications/ebola/ebola-case-definition-contact-en.pdf?ua=1 Talk about confusion on the ground. I wonder if they'll standardize? In practice the answer seems to be "adopt MSFs practices" because they seem to be working the best. On an aside: you mentioned ELWA-2 earlier. There were a few tweets going around today that said it had released survivors today. Hopefully that's accurate because survivors  but also because that means it's still up and running.
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Sep 11, 2014 03:27
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There's updates from DRC: 72 cases, 40 deaths; two MSF treatment centers opened, resources stretched, not all contacts yet traced nor projected containment date known. Regarding ECDC case definitions, http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?List=8db7286c-fe2d-476c-9133-18ff4cb1b568&ID=1062 ECDC posted:High-risk exposure criteria E: Good to hear about ELWA-2. I know they had a few escape issues and infected security staff, I was worried they might've had a bad situation turn worse on them.
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Sep 11, 2014 03:36
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Some other highlights, if you can call them that: There was discussion before about the case fatality rate and why it might be a poor indicator. HealthMap recalculated the CFR with a sixteen day lag to calculate case fatality:  80-85% -- ZEBOV territory. Next, a neat interview with CJ Peters, who used to be head of special pathogens at CDC: http://www.pathogenperspectives.com/2014/09/ebola-q-with-dr-cj-peters-what-my.html One thing that really caught my eye: quote:blood/serum from a survivor won't help here anyway. There's no evidence that it will help, but strong evidence that it won't help. The author promised a follow-up post there, and I'm really interested in seeing that. Serum has been used before for EVD/MVD but I never saw anything conclusive. Finally, I'd seen this before and the interview reminded me of it - the CDC has a big PDF about how to control infections in African settings, where advanced training and equipment isn't present. Neat stuff. E: ^^ It hasn't spread out of Boende, right? Johnny Cache Hit fucked around with this message at 03:51 on Sep 11, 2014 |
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Sep 11, 2014 03:48
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Johnny Cache Hit posted:Some other highlights, if you can call them that: This is a good methodology, but it seems like WHO have enough microdata at this point to give an actual fatality rate, rather than people having to rely on estimates.
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Sep 11, 2014 03:53
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Johnny Cache Hit posted:Some other highlights, if you can call them that: You should read the ECDC Risk Assessment for the best answer http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?List=8db7286c-fe2d-476c-9133-18ff4cb1b568&ID=1061 I wouldn't want to be within three week travel from Boende, given the long incubation period of this strain. In previous DRC outbreaks, cases have been known to travel over 1,200km between initial infection and becoming infectious.
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Sep 11, 2014 04:07
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