More people should understand that hospitals are messy. Really messy. From wiping vomit to feces to rolling over patients to changing chucks to wiping down monitor cables to handling bottles of saline that you may inadvertently leave out in the open for others to touch to not disposing spare gauze that may be contaminated to forgetting to wipe down your stethoscope to tearing your gown off as you rush to see another patient, etc etc etc. There are any number of people going in and out of a patient's room, performing a wide array of tasks, handling an even wider array of objects. Add to that the often hurried nature of hospitals and you get an environment prone to breaches of protocol.<p>I say this not to incite panic, but to provide insight that many might not have. It is more likely that during the thousands of interactions that this patient saw, the messiness led to a breach, instead of the virus infecting via a vector we've not yet realized.
PPE is hard... Every time you take it off is an opportunity for infection. It's very easy to get complacent and not be as careful as you should be (yes, even when dealing with something like Ebola). When you're donning and doffing dozens of times a day, mistakes happen. It's very likely she wasn't the only one to be exposed, but hopefully she's the only one that was infected.
Entering panic mode too fast, according to the chief of the CDC "there was a breach in protocol"[1]<p>Frankly, this hospital mismanaged the index patient from the beginning and though the woman infected now wasn't on the initial list...the list itself wasn't complete because they didn't properly diagnose the index patient ebola to begin with.<p>[1] <a href="http://www.cbsnews.com/news/cdc-chief-on-second-ebola-case-there-was-a-breach-in-protocol/" rel="nofollow">http://www.cbsnews.com/news/cdc-chief-on-second-ebola-case-t...</a>
As reported in this news story, "'Clearly there was a breach in protocol. We have the ability to prevent the spread of Ebola by caring safely for patients,' [Thomas Frieden, head of the Centers for Disease Control and Prevention] said in an interview Sunday on CBS’s <i>Face the Nation.</i><p>"Frieden also promised that protocols at the hospital would be reexamined to find out how the disease was apparently transmitted." Other patients with quite advanced cases of ebola, who were on the brink of death, have been successfully treated in United States hospitals without any health care workers in those hospitals being infected so far. The Dallas hospital where this latest incident happened will definitely have to review its infection control protocols, but we know already that other United States hospitals are doing things right.<p>Terrifying news like this came out when SARS was first spreading around the world in 2003. SARS is especially easy to transmit from one person to another because it is an airborne virus. No doubt there will be other cases of ebola infection spreading in the developed world, even in hospital settings, now that the first few cases have been discovered. But SARS transmission decreased a lot once people in China started taking precautions like self-isolation and masks to cover coughs. West Africa has a lower availability of equipment, supplies, trained personnel, and even information today than rural China had in 2003, but with sufficient outside help the transmission of ebola can also decrease a lot, until numbers of new cases start falling instead of rising.
The WaPo headline is rather sensationalist.<p>Of course he was wearing protective gear (it would have been news if he <i>hadn't</i>).<p>He may have worn it, but what procedures did he follow for removing it? That's where infections are likely to occur - the article even notes at the very end that the nurse in Spain who was infected was probably infected this way.
There was an Ebola documentary on PBS a few nights ago and one of the people noted that he touched a need and that's how he contracted Ebola.<p>People have likened Ebola to HIV, but HIV does not transmit this easily. Even during seroconversion (which is when you might get vomiting and such with heightened viral load) I've never heard of anyone contracting HIV in a hospital.<p>I feel like the information on transmission has been poor. For example, is skin a barrier for the virus?
A lot of this thread is speculation. Let me interject by actually citing some research which may answer some questions.<p>@kenjackson: "Is skin a barrier for Ebola?"<p>Yes. According to Bausch et al.<p>"Taken together, our results support the conventional assumptions and field observations that most EBOV transmission comes from direct contact with blood or bodily fluids of an infected patient during the acute phase of illness. The risk of casual contacts with the skin, such as shaking hands, is likely to be low."<p>In the same paper, they note that:<p>"We found [Ebola] to be shed in a wide variety of bodily fluids during the acute phase of illness, including saliva, breast milk, stool, and tears. In most cases, the infected bodily fluid was not visibly contaminated by blood."<p>This lends credence to Kyro and JshWright's assertions that hospital and PPE protocol are hard to exactly follow, every time (I'm certainly guilty sometimes). Even if the equipment or chucks aren't stained with blood, there is a possibility that the patient's tears have leaked onto the material and remain unseen.<p><a href="http://jid.oxfordjournals.org/content/196/Supplement_2/S142.full.pdf+html" rel="nofollow">http://jid.oxfordjournals.org/content/196/Supplement_2/S142....</a>
I posted the following in the now killed thread (<a href="https://news.ycombinator.com/item?id=8444976" rel="nofollow">https://news.ycombinator.com/item?id=8444976</a>):<p><i>As many commentators undoubtedly will say, additional cases are to be expected. However, it's a problem that both in Texas and Spain, the people infected have been health workers. Health workers that are supposedly well-protected and well-informed about Ebola specifically (at least the spanish nurse was, it's not clear in this case yet).<p>Now it's true that there are more bodily fluids in a hospital than outside, but given all the protection and procedures, is the difference so big that a health worker is at a much bigger risk than a person who happen to sit next to someone infected on a bus?<p>There are two cases as I see it. Either it's likely that other people, non-health workers, have been infected. We just don't know about it yet, or it has been decided that it's not in the public's interest to know. Or the protective measures are so bad, the disease so misunderstood or hard to protect against, that health workers effectively can't protect themselves against the risk.<p>Either case, it's a big problem. In the west too.</i><p>In that thread people were saying the health worker was infected before they knew Duncan had Ebola. In this thread, when it turns out that the health worker did know Duncan had Ebola, people are saying that it's obvious. Funny how these things work.<p>No one except mainstream US media is advocating panic. That doesn't mean it's not a serious issue that requires our attention. Saying "Ebola is overrated, more people die of X every year, don't panic ffs" doesn't add anything to the debate - it's neither controversial nor insightful.<p>To guide the discussion, here's a suggestion for people who disagree with me. Either argue why there are more than the two cases that I outlined, or argue for why either of the two cases aren't a problem in the coming weeks and months.
So far this hospital has completely screwed up both in providing medical services and explaining what happened. Does it really make sense that an apparent emergency room worker would be wearing full protective gear including a face shield before they had even diagnosed Ebola? And if so how did the virus get through? Magic? No somebody, most likely the infected person, screwed up. All it takes is a touch of your comtaminated gloved hand to your unprotected face.<p>Like when they blamed the computer system then later denied it was a problem or when they said the initial patient's fever was 101 and it later turned out to be 104 we may have to wait for the truth to come out, if it ever does.
At some point, we're going to have to talk about how this black, uninsured man walked into a Dallas hospital, which discharged him and then later lied about his condition when he first went to a hospital. And we're going to need to talk about Republicans slashing CDC funding and every other type of public health funding they could get their hands on. And we're going to need to talk about how the two white Christian missionaries got flown directly to a specialized hospital in Nebraska immediately upon diagnosis, and survived.<p>(edit: very predictable downvoting on this. But it's simply a fact that politics and race have played a part here. I don't like posting it any more than you like admitting it to yourselves.)
<a href="http://www.washingtonsblog.com/2014/10/screening-ebola-taking-temperature-cant-work.html" rel="nofollow">http://www.washingtonsblog.com/2014/10/screening-ebola-takin...</a><p>"Some Ebola experts worry that the virus may spread more easily than thought -- through the air in small spaces, for example."<p>Aerosol transmission is a very real possibility and has been demonstrated in the field and in some experiments, including working its way through the air ducts of a building, from one part to the another, infecting monkeys, and not just through one room.<p>Though some strains are not as effective in that mode of transmission as others.<p>edit: To the down-voters, at least make your case. The people that worked with the virus, and in the hot-zones, made theirs.