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Wow. I just don't know where to begin.

'And she has replied; "my Daddy does not have Ebola." 'She said; "Everyone should stop calling me because my dad does not have Ebola."

She is also refusing to seek medical attention. We are damned.

Post # 85 in the PF Metals Ebola forum:

http://www.tfmetalsreport.com/comment/437365#comment-437365

The Ebola Potential Hits Home in our Emergency Department
The public realization that Ebola is here in the USA has been like an electric shock through our hospital’s emergency department and EMS staff. We are stunned--standing motionless like the deer in the headlights. What do we do? We have absolutely no workable protocols in place for how we would deal with patients suspected of Ebola infection. Absolutely none. Our usual infection control procedures have evolved around the agents we traditionally face: aerosol and blood borne pathogens (Influenza, TB, Hep C, HIV) which require one approach, and low lethality contact pathogens (C. Dif, MRSA and VRE) another. But when a high-lethality pathogen like Ebola shows up, spread by contact, blood, large droplet spray, and is known to persist on surfaces for hours—we have absolutely no effective procedures in place. This is completely new.
Imagine this scenario: An African standing in front of the triage nurse in the ER lobby says: “I am just returning from Sierra Leone where I cared for my mother who just died of Ebola. I have a fever and headache and feel really weak. I need to lie down right now.” Then she vomits and slumps down onto the floor.
The act of vomiting puts large infectious droplets into the air splattering all surfaces within several feet. The nurse and EMT at the triage desk should assume that the droplet spray covers their clothing, hair, exposed skin, eyeglasses and shoes. The triage staff needs to immediately stop work, go take a shower, change clothes and shoes before returning to patient care. (How would you feel about having your blood pressure checked by a nurse and using equipment known to be covered in an Ebola infected droplet spray?)
Problem #1: There is no staff shower readily available. (The hospital was not designed for Ebola care.) Most workers do not have a change of clothes (though extra scrubs can be found in the OR) and none have a change of shoes. What are our viral disinfectant procedures for staff showers? What becomes of the washcloth and towels used? How about the surfaces of the bathroom itself? Would you be comfortable showering in a shower last used by an Ebola splattered person?
Problem #2: The area around the triage desk including the walls, computer, blood pressure cuffs, chairs, scales, clipboards, floor and desks are now infected. Paper forms, ball point pens, measuring tapes, penlights must all be discarded. The area is unusable pending decontamination. This is the type of break in usual-procedures that also brings the care of non-Ebola patients to a halt.
So, lets imagine housekeeping gowns up in PPE, sprays disinfectant and wipes the surfaces down with a rag. How about the computer monitor and keyboards that can’t be sprayed? What do we do with the now infected rag? It cannot go into the regular laundry. How do we handle infectious linens?
The plastic suits (the personal protection equipment--PPE) are only useful when coupled with decontamination. The outer surface of the housekeeper’s gown becomes covered with infectious droplets. She needs decontamination—an assistant who can spray her down with dilute Clorox and carefully help her out of the gown so that she does not touch the outer surface during the removal process. (I understand that removal of the PPE is the most dangerous part of patient care.) Where do we do this? Outside the department entrance on the sidewalk? This is the only place I can think of. This should work until winter snow begins to fall. Again, the hospital was not designed with this process in mind. The gowns must be hung up to dry as they are infectious until dry.
Problem #3: Back to our patient, who is lying on the floor of the hallway covered in vomit with a very low blood pressure? The vomitus covering her skin and clothing is ladened with Ebola virus and HIGHLY infectious. For a health care worker to touch the vomitus with bare skin would be suicidal. Only those dressed in a plastic PPE suits should even consider contact. We will need 4 people to “suit up” in PPE gear (10-15 minutes), lift the patient on a gurney and roll her down the hallway to a patient care room. Then, these people must step into a bucket of bleach to decontaminate their boots, then proceed directly to the decontamination area without walking through hallways or touching or being touched. Decontamination and “de-suiting” will take another 30 minutes and the time of several more “hygienists.”
Problem #4: Managing vomitus and diarrheal stool, of high infectivity, on the floors and walls of high use public hallways. What is the disinfectant solution to be used? Can the mop itself be reused? How long does the floor need to dry? How will we function with the main hallways closed for decontamination? Where do we dump the dirty mop water? In the public sewers? And, again, the housekeepers need decontamination.
Problem #5: Impact on the families of hospital workers. So the shift is over, its time to go home. The healthcare worker (HCW) knows that they have been splattered with secretions from Ebola infected patients. They think that probably they have been careful enough. (Though there is a faint memory of brushing a bare arm against a wall where a vomiting patient had passed…..) They have done their best, decontaminated, showered, dried off, changed clothes. Was it enough? Do they go straight home and climb in bed with their spouse? Do they hold their children, kiss them goodnight, cook diner for them? Or is it prudent to stay away from their families for 7-10 days (average incubation period is 6-7 days)? We are considering 10 days of quarantine after EACH WORK SHIFT. And most doctors and nurses work 4-5 days a week, they would cease to live with their families for the duration of the epidemic? Will the hospital or community provide Ebola HCW housing?
Pregnant HCWs. Ebola sepsis produces hypotension and shock. Even if the mother survives the fetus is unlikely to. Many of our nurses are pregnant.
Husbands, will weigh the risks and impacts of losing their HCW spouses. I am absolutely certain that many, especially young mothers, will decide to leave patient care until the epidemic has passed.
The reality is that all Ebola care is voluntary. Hospitals will realize this up front and ask for volunteers, or find out the hard way when HCWs do not show up for work.
[I posted on facebook about the Ebola epidemic several which apparently opened the topic up for discussion. Several physicians and nurses have privately confided that they will not be doing any Ebola care for any reason. “Who will raise my children?” “Martyrdom against an epidemic of this ferocity has no purpose and will do no lasting good.” “The day the first Ebola case arrives will be my retirement day.” “This should have been stopped at the border.” “Will I clean up the sh*t of a stranger who is dying anyway, knowing that my own children will have to be raised in some orphanage? Hell no!”]
This portends a sudden, and completely foreseeable, collapse of our hospitals should we attempt to provide care for significant numbers of Ebola patients in the hospital setting.
My conclusions are that if the Ebola epidemic becomes significant:
1. There will be a sudden, immense attrition of hospital workers.
2. Attempts to mix Ebola care with traditional hospitals will cripple the entire hospital by disrupting all of the usual procedures. The result is that no-one, not even non-Ebola cases, will get hospital care.
3. Dedicated Ebola care centers and home care by the families of patients will be adopted, not because they are great, but because the alternatives are so unworkable. Most Ebola care is supportive, IV fluids, cleaning, feeding. An unused National Guard dormitory might be a decent place for this.