Ebola: America Has Something to Fear-Ill Preparedness

Current Trends by Natasha Sapp

Before early fall this year Ebola was an exotic disease from half a world away, a plight effecting people from countries few had ever heard of synonymous with starvation, abject, extreme poverty, the poor sanitation, nearly nonexistent medical facilities, no preventative medicine found in third world, developing nations, the kind of thing that pulls at our heartstrings but doesn’t keep us up at night. That shifted slightly when American doctors, American aid workers were diagnosed to have the almost always fatal disease and flown back to U.S. soil for treatment; still these were doctors, missionaries, individuals who knew the risks of exactly what they were walking into, chose to be there, not stranded tourists. Everything changed when the first American was found to have contracted Ebola after visiting family in Liberia; fears grew as critical lapses leaked to the media and thus the public, knowledge Thomas Eric Duncan was initially sent home with antibiotics after coming to the hospital with a fever, one of the beginning symptoms, anxiety mounting viewing footage revealing people in hazmat gear sanitizing his and his family’s apartment, the sheer number of people shuttled into nearly month long isolation, health workers knocking on neighbor’s doors. Then Duncan died October 8th; 5 days later nurse Nina Pham was identified as the second American case post going to the hospital the previous Friday. Just two days to digest that and we are hit again with the fact yet another nurse has been confirmed infected; this time Amber Vinson earns a designation no one wants, the third American case of Ebola. A mere one day later a cruise ship carrying a lab worker who handled samples from Duncan, self-quarantined in her cabin when she got sick, is denied entry into Belize and forced to return to Galveston Texas, making everyone across the country nervous; particularly since all the periphery cases are tied to those who treated Duncan, the hospital who first missed his true diagnosis. Amidst Belize’s actions being called an abundance of caution along with the closing of some Texas schools, the bridal shop Amber Vinson was in before knowing she was sick, amidst experts, officials warning hysteria is currently more dangerous than the disease, the question remains; is it hysteria or is it a justifiable response to an obvious lack in procedures, protocols, safeguards, even basic understanding regarding a potential pandemic? Not by the average lay person, citizen X American soccer mom, working class dad, young college student, but by experts, officials, heads of departments for entities like the CDC; proving not only are we unprepared, but that millions would die for a lack of trained medical staff, organization, interagency cooperation, that left unchecked, could someday devastate beyond third world Africa, beyond America to decimating the entire world’s population.         

As if the timeline wasn’t frightening enough, the sequential events happening in such quick succession, outside the slowly permeating idea even here in America with the advents of Western medicine, modern, functional medical facilities, equipment, a literal place, space for people to go when sick, sans superstition about both hospitals and common medical practices in the 21st century, knowledge of infections like Ebola and precautions to prevent spread, those treating the ill can quickly become ill themselves, remains the gravity surrounding how big a bullet we may have just dodged. Because, come to find out, all those regulations, safeguards, protocols and procedures are either non-existent, not being followed, outdated or designed for the West African bush handling significantly lower numbers of people in less densely populated areas, totally different cultural, living and travel patterns than the tightly packed, major metropolitan cities comprising U.S. urban geography, housing major mass transportation hubs and the ready occurrence of plane flights cross-country. Still said realities don’t account for the abysmal, downright incompetence uncovered at Texas Health Presbyterian and other key, this time, governmental agencies nationwide by the public health crisis. Problems beginning with the hospital; across the country Ebola became a general discussion topic when the second missionary sickened and was returned to America to be treated.  Roughly the same time hospitals were put on alert to look for patients having recently traveled to specific African countries as outbreak figures, conditions there reached historic proportions, things taking place close to a full 2 months before Duncan wandered through the doors at Texas Health Presbyterian. Yet cold hard facts tell us Thomas Eric Duncan was sent home carrying antibiotics and a health checklist for a sinus infection, ruled out via CT scan hours later, despite being completely open, honest and truthful about his travel history to Liberia, an Ebola hot zone; his hospital medical records show abnormal blood and urine samples put beside travel information that should have tipped doctors off enough to isolate and test Duncan for, you guessed it, Ebola. Once his true malady was correctly identified, a bad situation only seemed to get worse; nurse testimony coming to light after two of her fellow coworkers Pham and Vinson were discovered infected, painted a picture best described as people running around like chickens with their heads cut off and hospital, not government, bureaucracy run amuck. Most shocking among her allegations, no one in charge of the protocols for a pandemic infectious, Ebola patient, people who might as well have been playing a game of telephone between on-site departments and the CDC, once they were called at all. According to news reports on air before the nurse ever dared speak in a public venue, hours passed where Mr. Duncan was left in an open area with other patients post diagnosis confirmation, two days went by before nurses caring for him were wearing full protection and two weeks after he was admitted and died hospital personnel continue to be lacking, unclear regarding their Ebola procedures. Regardless what spin Texas Health Presbyterian tries to put on it in hind sight, their staunch defense they did everything they could for Duncan, not only did they fumble his original diagnosis, he was not afforded the same experimental drug given to the now recovered missionaries, seemingly not entertained as an option either due to limited availability or the hospital never making inquiries about where they could get it; it’s hard to tell which. Further their chief clinical director, head of the entire hospital, admitted theirmea culpa to ABC news’ chief medical editor Dr. Richard Besser, saying in part: “we were ready for a person who walked in wearing a sign that says ‘I have Ebola,’ but in what scenario is his statement anywhere close to what would, could actually happen? People who usually come to the E.R. are decidedly ill or injured, bleeding profusely, suspected to be having, just had a heart attack, broken a limb or had lingering symptoms that will not go away including fevers, known to alter mental states alone, but pneumonia, stomach viruses and other treatable, benign ailments routinely cause people to feel utterly miserable, making it that much more difficult to get an accurate history, clear cataloging of symptoms. Meaning someone who knows Ebola, other pandemic contagion may be a possibility isn’t necessarily capable of telling you, remembering said possibility, so, you being doctors, being in full possession of your faculties, must ask the questions. Including, have you traveled outside the United States, yes/no, been in contact with anyone who has traveled outside the U.S. yes/no, if yes, where did you go, where did they go, and to be on the safe side, run the test(s). Absolutely when told they have definitely been to an exotic place, test for the possibilities in that area, no excuses, no exclusions, no exceptions.                 

Now Briana Aguirre, our highly vocal, viewed as a whistle blower nurse, is being called everything from an inexperienced nurse, having only 3 years in the job, to a person who is too unintelligent to be a nurse from the get go, owing to not thinking she should absolutely attend a training session on pandemics, contagions, Ebola, keep herself apprised of possible threats whether her bosses do, offer the opportunity, or not. A person who, not treating Duncan really has no clear idea what did or didn’t transpire during his care, to ruining her career by speaking out; however, she did care for her fellow nurse Nina Pham when she was stricken ill, reported on protocols more than 2 weeks after Duncan was diagnosed and 5 plus days after he died that were still not up to par. Additionally mock ups showing clear differences between hazmat suites worn in Africa vs. what was worn in Texas over the course of Duncan’s treatment seems to corroborate her account more than an exposed neck, which with plastic face shields may or may not have posed a huge safety risk, violation. Cursory visual inspection finds no tape sealing sleeves to gloves, suite legs to shoe coverings, no drape covering the neck before applying face mask and shield, nurses told, upon raising concerns, to use medical tape to close the neck gap, likewise informed equipment was on order but had not arrived yet. Matt Lower’s interview on the Today show brought up a simple, common sense question about why other adjacent hospitals weren’t called to see if they had the whole body hazmat suites to use? CNN was able to verify both what Aguirre relayed to multiple news programs and compound damming evidence via a nurses union statement referencing first contact with Duncan only included standard gowns, gloves, surgical masks, hazmat gear only available in the wrong size, hazardous waste piling up because housekeeping didn’t know how to dispose of it properly. Doctors, nurses reportedly monitoring Duncan told, because they were in suites, to go on to the next patient’s room, continue normal patient care duties. Lab specimen tube system potentially contaminated because his specimens were not given extra sealant, hand delivered; fellow patients at the hospital possibly exposed to a highly contagious Duncan were kept in isolation one day then ordered to other parts of the hospital, even those with fevers, standard isolation to determine Ebola infection, 21 days. Aguirre stating prior to his arrival, her hospital, Texas Health Presbyterian had never so much as discussed Ebola, pandemics period with staff, there was no drill, no review of protocol other than a vaguely mentioned seminar neither hands on nor mandatory. Leading to the obvious question, how can you be alerted to a known deadly contagion, told to be on the lookout and not brief staff, not make training mandatory, hold seminar several times, in small groups with live, hands on demonstrations ensuring every nurse gets the information, can assimilate it adequately? Subsequently what was a nurse holding a license no longer than 3 years, admittedly not an isolation nurse, having the needed training for that environment, the dangerous infection there doing helping treat her coworker Nina Pham in the first place? What were the skill and experience levels of the nurses charged with Thomas Eric Duncan’s care; examining their ages, the 2 we now so infamously know are fairly young, a few years out of nursing school Pham 26, Amber Vinson 29, Aguirre herself 23. Where are the people with 5, 10, 15 years experience who should have been at the forefront; hospital administration knowing they lacked proper protection suites, realizing staff were untrained, why didn’t they request the CDC remove Mr. Duncan to one of the 4 specially trained, specially equipped, designed to handle pandemic hospitals available in the U.S.?  Absorbing this information, we are lucky every nurse who treated Duncan was not infected, did not infect numerous people before landing in a hospital.

Speaking of Vinson she’s getting nearly identical scorn from the public as Aguirre called reckless, careless, stupid, self-serving chiefly because she had close contact with an Ebola patient who died then flies half way across the country potentially exposing hundreds to a deadly disease; being a nurse she know she shouldn’t needlessly expose herself to others, isn’t that common sense was the resounding question. Except she contacted the CDC before flying, told them where she worked, what she’d had exposure to, noted her low-grade fever, she was then cleared to go ahead with her flight by both the CDC and Dallas county health officials; they originally said, because her fever was under the 100.4 threshold. Plus, very public reports by outspoken family members defending Vinson’s actions detail, when she found out about Pham, she requested to be taken back to Dallas, a request denied for unfathomable reasons. Citizenry latching on to revised CDC press releases, Q&A sessions indicating, again in hind sight, she should not have flown being part of a group who treated Duncan, who was engaged in self-monitoring; hold on, being told she should not have flown, should not have been cleared to fly is not the same thing as being warned not to fly, being told to avoid public transit. All things it would make sense she should have been told, sadly never was either by her employer, the hospital, or the CDC; bringing us to the ever changing stance presented by the CDC itself. An agency that went from confident Ebola would not reach the U.S. to alerting hospitals to look for travelers from West Africa, who went from pointing out that every hospital, though not specifically equipped for pandemics like the exclusive 4, remains capable and trained to handle infectious disease to announcing the first, second and third U.S. cases, missteps and a missed diagnosis in case 1, probable breaches in protocol resulting in cases 2, 3. Who said that while healthcare workers, hospital heads when asked, by news reporters, if they had hazmat suites to use were saying not that I know of; who called case 1 an isolated incident, then post case 2 told a national audience of the lingering potential for more. The CDC (centers for disease control and prevention) responsible for devising protocols, procedures, guidelines, keeping the public, healthcare workers, everyone safe constantly issuing new and conflicting restrictions, rules, mandates as the crisis unfolded. Yes there is needing to adapt to changing situations and circumstances but the parameters and road maps advised for immediate implementation to combat Ebola on American soil scream things they should have done, been doing from the beginning; some, things you do in dealing with any infectious disease of which Ebola is only one. Any phone jockey, person whose job it is to do nothing but field calls, at the CDC ought to be trained to say you work where, you were exposed to what, no you shouldn’t fly, you should be in quarantine, they’re only doing self-monitoring where, let me get my boss on the phone. Instead Nina Pham got sick and nurses who treated Duncan were still not told they were barred from flying, barred from using mass transit and it was well after Amber Vinson was diagnosed nurses were offered beds for professional monitoring still lacking the concept of mandatory, get here or we will track you down; failures of both the hospital and the CDC.  

http://www.cbsnews.com/news/ebola-nurse-called-cdc-several-times/

Secondly reasonably criticizing the CDC’s ineffective response to arguably the biggest American public health threat since small pox, typhoid, they knew the second and third American cases showing up stemmed from contact with Thomas Eric Duncan, mistakes in his care and questions about the quality thereof already being raised at the time: nevertheless, Nina Pham understandably came to the hospital where she worked to receive treatment. But then was left there by both hospital officials and the CDC; the former learning from very recent experience just how unprepared, unable to cope they really were. The decision to relocate Amber Vinson wasn’t a matter of who was better acclimated to care for her, who actually had the needed expertise to execute her case, the CDC stepping in, seeing the poor job a “regular” hospital not designed to do this did, saying we’ll take it from here, to prevent spread sending to one of the specialty 4, rather a simple matter of staffing.  She was moved primarily because they already had an Ebola patient to treat and thought 2 was too many, expecting sick outs and staff too fearful to come to work; only after the horrifying state of things at Texas Health Presbyterian was circulating on every news outlet was Pham also moved. Returning to the Aguirre outlining of events within Texas Health Presbyterian, 3 hours apparently went by before first contact was made with the CDC; what was the content of that conversation, why was the lone American case of Ebola left in a general hospital at all? Kent Brantly and Nancy Writebol, the evacuated missionaries, were released from the hospital a full month before; the journalist covering Ebola inside Africa, contracting it while there, was the only remaining case, meaning there was at least one specialty hospital capable of taking Duncan. And since there weren’t hundreds, thousands, millions of Americans sick, flooding local, rural, county, metropolitan hospitals nationwide, wouldn’t prudence dictate erring on the side of caution?  Coming to the conclusion to leave Duncan in place, you don’t issue guidelines to hospital officials, in the technology age, set up video conferencing directly to nurses to A- hear them tell you they don’t know what to do, list equipment they don’t have? B-finding no problems present, no complaints, red flag questions issue guidelines to healthcare workers treating a confirmed Ebola case that they should not be treating generic patients, no commercial plane flights, no public transportation, those treating him should be in quarantine when not on duty, none of this self-monitoring crap? New procedures involving Ebola, similar contagions will now include immediate dispatch of rapid response teams to the area hospital and arranging expedient transfer to one of the 4 trained hospitals across the US.; begging the question, why wasn’t that standard operation already?  Since, contrasting the fates of Pham and Vinson, none of Thomas Eric Duncan’s family living with him is sick; his fiancé describing sleeping on the sweat soaked sheets still coving the bed they shared. Yet they were released from quarantine last week Ebola free; to date none of the periphery people Duncan, Pham or Vinson were in contact with, preceding their diagnosis, are sick. The cruise taking lab worker found to likewise be Ebola free along with other isolated caution cases; an additional doctor out of New York confirmed to have the disease contracted it working in West Africa. Nancy Writebol, Kent Brantly were treated successfully sans infecting anyone, an identical outcome regarding the journalist, hugely positive, they also lived. Leaving us with the question what the hell happened at Texas Health Presbyterian?                   

Others fault the Whitehouse, the president and Washington for being slow to respond to a national public health threat, but this isn’t about a failure from the top down to lead in a crisis, this isn’t about how long it took to appoint an “Ebola czar,” a head liaison to coordinate everyone, to brief the American people or who he appointed to the position, the sticking point that Ron Klain has no medical training. Predictably people lodging complains about Klain’s credentials are the same republicans who refuse to confirm the president’s choice for Surgeon General, who refuse to allow a vote, some who seem not to even know we don’t currently have a Surgeon General, the same, ‘they’re taking our guns away,’ conservatives who support republican obstruction because the president’s nominee dared call unregulated proliferation of guns a public health threat. The Surgeon General who probably should be briefing the American people on Ebola, who is best suited for the task, yet that isn’t what Ron Klain was hired to do, to fill a noticeable gap in government staffing. Mr. Klain was hired to coordinate, facilitate communication between government agencies’ focused on guarding the public health, monitoring infectious disease, making sure everyone is talking to each other, on the same page. Ultimately, at the end of the day, Surgeon General or no Surgeon General isn’t significantly consequential either; what is: readiness on a state and local level, our current complete lack thereof. It is indicative of how states have been allowed to drastically slash budgets, eliminating police, fire, paramedics, cutting hours, workers at local social security, social services offices, cutting funding to local health departments, phasing out the jobs of the very people who were instrumental, or could have been, in handling this within the state, the county, the city. Sadly revisiting what happened during hurricane Katrina, super storm Sandy, natural disasters proof positive emergency evacuation plans are out of date commensurate with population, haven’t been practiced by law enforcement, emergency, evacuation personnel, cities and states don’t have the means to transport citizens to safe zones in large numbers leaving people vulnerable no matter how fast the national government response, FEMA or otherwise is also apparently all too true concerning contagions; hospitals sans equipment, training, knowledge critical to actions saving an infection person’s life, preventing spread to others. And is anybody truly surprised this happened in Texas a state littering headlines for all the wrong reasons, a state governed by Rick is he medicated, does he need medication Perry who thinks the biggest threat to his state is illegal immigrant unaccompanied minors, mothers and young children infiltrating his boarders with contagious but treatable skin maladies solved via the most basic medical care. A concrete tangible threat came to be, once Texas knew what they were dealing with, finding a local sanitation crew that had more than simply the proper training, the proper tools to go in and clean Thomas Eric Duncan’s apartment, rather was willing to touch it with a ten foot poll, was willing to set foot in it in order to perform the needed decontamination. This is about in Liberia, ground zero for Ebola, people flying out of the country are required to have their temperature taken at minimum twice and mandated to fill out a questionnaire to determine potential contact with the infected; here there is an ongoing debate over banning flights from that part of the globe but, ironically as an MSNBC commentator pointed out, no mention of banning flights from Texas where all American cases are concentrated. It took Thomas Eric Duncan dying for U.S. government agencies, health experts to mobilize that effort, began just last week vs. Liberia, citizens themselves likely surprised paper, printer ink could be found in quantity to produce the questioners, the writing implements to write, mark answers, or did they have someone hand write questionnaires in pencil, use chalkboards, have singular laminated copies read them then have screeners listen to the answers?  Here again, passports of people coming from West Africa weren’t flagged for a cursory visual inspection of the person for health, cataloging how many were coming and going, contact info in case they needed to be found; a point poignantly illustrated by ABC’s Dr. Richard Besser whose passport was flagged at a major U.S. airport due to his extensive reporting on Ebola in Africa, his face routinely on the news, not because there was a system in place, parameters being used to monitor anyone for disease.         

These things being bought to light, let’s remember the failure centered around one hospital, one pivotal, but singular, government agency; remember Texas Health Presbyterian, congress, airport workers, local health officials were following the original guidelines of the CDC. Guidelines okaying the lesser hazmat suites for nurses, deciding times for rapid, any response deployment to aid hospitals treating an Ebola patient, the CDC who left cleanup of Thomas Eric Duncan’s apartment in local control not their own. Texas Health Presbyterian who, to public knowledge did not demand the CDC remove Duncan to a specialized hospital, nurses willing to speak on T.V., willing to disclose things via a union, never once again, to public knowledge, calling the CDC themselves to report conditions in their hospital, how things were being addressed.  Much hay has been made about the personal choices of Amber Vinson to fly but there is obviously merit in another commenter question asking, “Why would she trust the a-holes at Texas Presbyterian?” More dissected the CBS news report highlighting nowhere did it mention her disclosure of where she worked, what she had been exposed to; doing something in a time limited segment lost on them one can suppose, because had she not revealed where she worked, who/what she’d been in contact with surely those questions would have been asked beginning with where she got the number for the CDC, why she was calling them, what made her believe she might have Ebola, something deadly infectious. If not the CDC, who should you call to ask about a potentially pandemic disease infection; she didn’t go to the Paramus mall, she didn’t seek out her regular physician, the county health department alone, she went straight to the source that ought to know, a source who steered her wrong.  If the government is to be blamed for anything it is the national cuts to facilities like the NIH (national Institutes of Health), the CDC, Health and Human Services, a situation engineered by republicans not President Obama. If the government is to be blamed for anything, try congressional members decrying allocated monies meant to combat Ebola because they spend too much money on Africa. Never mind unless the outbreak is quelled at the source, yes in Africa, we will continue to have to combat Ebola on American soil, as doctors helping there return home, as Liberian nationals refuse to be permanently separated from their family any longer. If the government is to be blamed for anything it is letting big pharmaceutical companies here take a pass on developing an Ebola vaccine because there is virtually no money in it, not allocating enough foreign aid, research dollars under government umbrella to shoulder the task, waiting until it is an American crisis to mobilize against the problem, thinking boarders alone create safety, security.            

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About Natasha Sapp

Proclaiming an edgy voice of reason to America,while bringing back the common sense to social issues.

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