Posted on 10/29/2014 7:19:34 AM PDT by Gritty
Edited on 10/29/2014 7:31:54 AM PDT by Admin Moderator. [history]
The patient was a 36 y.o. male epidemiologist who became infected in Sierra Leone, probably by a colleague with whom he shared an office and bathroom. Said colleague contracted Ebola and died.
Patient was treated for malaria at first, by quickly became symptomatic of and tested positive for Ebola. On Day Ten after initial symptoms, he was transferred to Germany for intensive treatment.
Day 1: malaise, headache, bodyaches
Day 2: Fever of 101.2 F
Day 6: Positive Ebola blood test
Day 7: abdominal pain, nausea, vomiting, diarrhea
Day 8: Beginning of IV fluids and single-dose antibiotics
Day 10: Transfer to German hospital ICU isolation ward in Hamburg
Blood tests: suggestive of massive dehydration, lab values totally f***ed up (that's a clinical term)
Ultrasound of inferior vena cava (the route blood from the body takes to get back to the heart) showed that it was flat. In other words, circulation was upgefuchten (German clinical term).
Patient shitting out more than 2 gallons of diarrhea per day for 3 days straight, and digestive tract blocked. Given 10 liters of IV fluid/daily, plus potassium supplements
Ebola blood concentration begins to decrease
Day 11: feeding tube placed
Day 13: vomiting stopped; Fever and general secondary infection noted, more antibiotics started
Day 15: central venous line placed; diarrhea decreased to less than 1 quart/day
Day 17: Ebola absent from blood concentration
Day 18: altered mental status and respiratory failure; placed on external ventilation
Day 20-25: hallucinations and delirium
Day 26: respiratory and mental recovery
Day 30: Ebola no longer detected in urine
Day 40: Ebola no longer detectable in sweat
Day 60: Patient discharged to return home to Senegal.
Truly, read the whole thing. This guy nearly died at least twice and perhaps three times; once when the Ebola nearly killed him, and again when the complications of Ebola caused bacteria from his digestive tract to leak out of it and into his body, causing a massive infection, and finally when the monstrous amount of fluid to stave off the Ebola, plus aspiration of blood caused lung and breathing problems, almost drowning him in his own fluids, and caused his brain to swell to the point of impinging on normal respiratory function.
By any standard, that medical team are rock stars.
WHY YOU AIN'T FIXING THAT AT HOME
1) The study was co-authored by 12 board-certified critical care specialist MDs, all of whom were directly involved in treating this one patient.
2) The patient was in the ICU, certainly what we call a 1:1, and probably more like a 4:1, i.e. at least one, and probably four nurses (two for care, and two to make sure the first two were sterile and safe) for his course of care, for at least 26-30 days of his care, if not the entire time.
3) 10 liters of saline/day times 10-18 days: $5/bag, 180 bags minimum=$900, and it's all Rx. (BTW, there's been a national IV Saline shortage for months, to the point that hospitals are having trouble getting enough, just FYI)
4) New IV tubing every 3 days, probably two sets, $3@, figure another $100, all Rx.
5) The associated supplies to start the IV, another $300
6) rare and exotic antibiotics, including the big guns for the drug-resistant infection he developed from what leaked out of his guts and into his body because of the Ebola Probably $5-10K worth, if you could get them
7) the full-body positive pressure hazmat suits and HEPA powered respirators that prevented one single reverse infection during the patient's treatment - $2K@
8) the x-ray, ultrasound, and CT scanners, roughly $1M worth, and all the techs to run them
9) the 24 hour lab, equipment, and specific tests to detect his various infections and run his blood tests
10) the sterile BL4 facility to house and care for the patient.
If you have a spare $10M to build that, and another $3+M/yr payroll to keep 15 doctors, including a pharmacist, radiologist, and pathologist, plus 24 ICU nurses to cover those shifts 24/7/365, and keep them all standing by for your family/friend/whatever, and all the ancillary staff as well, ROWYBS.
Of course, for a lot less, you could have bought and fully stocked one of those old missile silos or obsolete commo bunkers, and skipped the problem entirely, being instead watching your collection of every DVD movie known to man, playing ping pong, and eating steak and lobster off the BBQ 7 days a week for the next ten years, right now.
But if you have that kind of money, you could open a for-profit hospital now, and fund making movies, and be raking in money hand over fist 24/7/forever, in which case you're likely too busy to read this blog.
You're sure as hell not going to pull it off clipping coupons and holding down any middle class job (or twenty) anywhere in North America.
...
Thanks for posting this, Gritty. I’ve been reading Aesop for several weeks now, and he’s called EVERYTHING in this crisis, including the consequences of stupidity.
Obama & Co. are criminally negligent - and it will result in a lot of people here getting sick (and then dead) because they will try to take care of their loved ones. ALL of which is preventable by simply quarantining the Ebola-infected nations. Yes, help them - by air-dropping supplies. But DO NOT ALLOW INFECTED PEOPLE TO COME TO THE U.S.!
How does Obamacare impact the US medical establishment’s ability to treat Ebola patients?
Ping
Bump
A link to this thread has been posted on the Ebola Surveillance Thread
Day 30: Ebola no longer detected in urine
Day 40: Ebola no longer detectable in sweat
That's 14 days from respiratory and mental recovery to no detectable virus in sweat and urine.
So, how fast were the two Texas nurses released?
You may be correct about the early treatment with anti-virals, and antibodies may help, too (from plasma).
There is the possibility that the timeline is either being messed with to keep the narrative intact in Duncan's case, or, even more likely, that the entire infection to symptomatic timeline is dependent on initial viral load and means of infection. (IOW, not so hard and fast as we have been led to believe.)
That opens another kettle of worms, especially when it comes to declaring someone "Ebola free" and safe to live a normal life. Longer quarantines may be indicated, both prior to declaring someone 'clean' and after infection as well.
Thanks for the ping!
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