U.S. Ebola Cases May Exceed Two Dozen by November.

Two dozen Ebola cases in the entire US isn’t really a lot. That is, unless they’re in your neighborhood. Those at greatest risk are health workers. Workers at Texas Presbyterian Hospital in Dallas must be terrified.

Another risk is the economic one. Panic over Ebola can severely affect airlines, hotels, restaurants,  theaters, shopping, and even voting. Ebola is a terrifying disease. Who wants to mingle when there is even the slightest risk of infection?

U.S. Ebola Cases May Exceed Two Dozen by November, Researchers Say.

By Michelle Fay Cortez and Lorraine Woellert

There could be as many as two dozen people in the U.S. infected with Ebola by the end of the month, according to researchers tracking the virus with a computer model.

The actual number will probably be far smaller and limited to a couple of airline passengers who enter the country already infected without showing symptoms, and the health workers who care for them, said Alessandro Vespignani, a Northeastern University professor who runs computer simulations of infectious disease outbreaks. The two newly infected nurses in Dallas don’t change the numbers because they were identified quickly and it’s unlikely they infected other people, he said.

Ebola
Ebola Virus

The projections only run through October because it’s too difficult to model what will occur if the pace of the outbreak changes in West Africa, where more than 8,900 people have been infected and 4,400 have died, he said. If the outbreak isn’t contained, the numbers could rise significantly.

“If by the end of the year the growth rate hasn’t changed, then the game will be different,” Vespignani said. “It will increase for many other countries.”

Staying Rational

The model analyzes disease activity, flight patterns and other factors that can contribute to its spread.

“We have a worst-case scenario, and you don’t even want to know,” Vespignani said. “We could have widespread epidemics in other countries, maybe the Far East. That would be like a bad science fiction movie.”

The worst case would occur if Ebola acquires pandemic status and is no longer contained in West Africa, he said. It would be a catastrophic event, one Vespignani says he is confident won’t happen.

“Let’s be rational for the next couple of months,” he said. “We aren’t going to have an invasion of cases. After November, we need to reassess the situation and see what is the progress of containment in West Africa.”

It’s reasonable to expect one or two more imported cases in the next couple of months, plus related infections in health care workers, he said.

It’s unlikely that Ebola will ever exceed 20 cases in the U.S. or Europe because of their extensive health care infrastructures, said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, a non-profit think tank in Washington, D.C. The problem in the developed world will center more on the economic impact, he said.

“The damage is not as much in the number of deaths as much as in the panic it creates and all the disruption it creates in trade and travel,” he said. “It’s important for public health officials to strike a balance between being serious and certainly not creating panic.”

“It’s not going to be like the movie ‘Contagion,’” he said.

The infection of two nurses who cared for Thomas Eric Duncan, the first person to be diagnosed with Ebola in the U.S., has some worried that the virus may be mutating and becoming more infectious. When trying to extrapolate those cases, people should remember five other Americans were flown to the U.S. for care, said Eli Perencevich, professor of epidemiology at the University of Iowa Carver College of Medicine. None of them transmitted the virus.

Average Americans shouldn’t see any risk from the virus outside of the medical community because patients aren’t terribly infectious until the disease peaks, Perencevich said. In industrialized areas like the U.S., those people will be in the hospital, he said. Health care workers, though, are uniquely vulnerable.

Hospital Fears

“There’s a high probability that there will be another person who comes in, no matter what we do, but the risk is in the hospital,” he said in a telephone interview. “As long as people who know they have been exposed to the virus get themselves quickly to the hospital, even after they have started a fever, it should be OK because they aren’t that infectious.”

Getting to the hospital could be difficult for some people, said Maria Cristina Garcia, a professor of history at Cornell University, who has written extensively about refugees and immigrants. While any international traveler could import Ebola, Garcia worries that the outbreak may give Americans another reason to fear or lash out against immigrants.

“An immigrant, like any other person in the U.S., is concerned about cost and confidentiality,” she said. “If he cannot afford a hospital stay, he might avoid seeking treatment until it’s too late. He might also fear coming forward for fear of stigma. Those of us who lived through the 1980s remember how Americans responded to the AIDS crisis during the early years.”

It’s possible that a handful of infected travelers could spread the virus to new areas, especially given its long latency period, said Jeffrey Shaman, who is modeling the outbreak at Columbia University’s Mailman School of Public Health. The models that show a possible range of cases in various countries are a good place to start, although there are so many variables that to some extent they are flying blind, Shaman said.

“Human folly and human nature plays into this,” he said in a telephone interview. “All these chains of human error can lead to these things emerging in little clusters. The real question is can we contain it.”

Read More: Ebola Cases

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Ebola Infected Nurse Traveled by Plane

Ebola Spreads in US. Plane Travel Will Suffer.

Ebola is here and it’s on the move. Passengers on a Frontier Airlines flight from Cleveland, Ohio to Dallas/Fort Worth International Airport may have been exposed to the Ebola virus. How about the workers who clean the plane? And the flight attendants and crew?  And workers at the airport? Incomplete protective protocol at the Dallas hospital may have profound consequences.

Second Texas Nurse with Ebola had Traveled by Plane

BY LISA MARIA GARZA AND TERRY WADE

A second Texas nurse who tested positive for Ebola after caring for a patient with the virus had traveled by jetliner a day before she reported symptoms, U.S. and airline officials said on Wednesday.

The worker at Texas Health Presbyterian Hospital in Dallas had taken a Frontier Airlines flight from Cleveland, Ohio to Dallas/Fort Worth International Airport on Monday, the officials said.

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The woman, identified to Reuters by her grandmother as Amber Vinson, 29, was isolated immediately after reporting a fever on Tuesday, Texas Department of State Health Services officials said. She had treated Liberian patient Thomas Eric Duncan, who died of Ebola and was the first patient diagnosed with the virus in the United States.

The circumstances under which Vinson traveled were not immediately known. But the latest revelation raised fresh questions about the handling of Duncan’s case and its aftermath by both the hospital and the U.S. Centers for Disease Control and Prevention (CDC).

At least 4,447 people have died in West Africa in the worst Ebola outbreak since the disease was identified in 1976, but cases in the United States and Europe have been limited. The virus can cause fever, bleeding, vomiting and diarrhea, and spreads through contact with bodily fluids.

“Health officials have interviewed the latest patient to quickly identify any contacts or potential exposures, and those people will be monitored,” the health department said in a statement.

During the weekend, 26-year-old nurse Nina Pham became the first person to be infected with Ebola in the United States. She had cared for Duncan during much of his 11 days in the hospital. He died in an isolation ward on Oct. 8.

The hospital said on Tuesday that Pham was “in good condition.”

News of the second nurse’s diagnosis follows criticism of the hospital’s nurses of its initial handling of the diseases, in a statement Tuesday by National Nurses United, which is both a union and a professional association for U.S. nurses.

The nurses said the hospital lacked protocols to deal with an Ebola patient, offered no advance training and provided them with insufficient gear, including non-impermeable gowns, gloves with no taping around wrists and suits that left their necks exposed.

‘PILED TO THE CEILING’

Basic principles of infection control were violated by both the hospital’s Infectious Disease Department and CDC officials, the nurses said, with no one picking up hazardous waste “as it piled to the ceiling.”

“The nurses strongly feel unsupported, unprepared, lied to, and deserted to handle the situation on their own,” the statement said.

The hospital said in a statement it had instituted measures to create a safe working environment and it was reviewing and responding to the nurses’ criticisms.

Speaking early Wednesday on CBS “This Morning,” U.S. Health and Human Services Secretary Sylvia Burwell declined to comment on the nurses’ allegations.

Dallas Mayor Mike Rawlings said at a news conference Wednesday that the second infected nurse lived alone and had no pets.

He said local health officials moved quickly to clean affected areas and to alert her neighbors and friends. A decontamination could be seen taking place at her residence.

EARLY WAKEUP

Residents at The Bend East in the Village apartment complex were awoken early Wednesday by text messages from property managers saying a neighbor had tested positive for Ebola, and pamphlets had been stuffed beneath doors and left under doormats, said a resident, who asked not to be named.

Other residents were concerned enough that they were limiting time spent outdoors.

“Everybody thinks this won’t happen because we are in the United States. But it is happening,” said Esmeralda Lazalde, who lives about a mile from where the first nurse who contracted Ebola resides.

Texas Health Presbyterian Hospital is doing everything it can to contain the virus, said Dr. Daniel Varga of Texas Health Resources, which owns the hospital. “I don’t think we have a systematic institutional problem,” he said at a news conference on Wednesday.

At the same briefing, Dallas County Judge Clay Jenkins, the county’s chief political officer, said authorities were anticipating additional possible Ebola cases.

“We are preparing contingencies for more, and that is a very real possibility,” Jenkins said.

The CDC said in a statement that it was performing confirmation testing of Texas’ preliminary tests on the new patient.

CDC Director Dr. Thomas Frieden said Tuesday the agency was establishing a rapid-response team to help hospitals “hands on, within hours” whenever there is a confirmed case of Ebola.

Frieden has come under pressure over the response and preparedness for Ebola, but White House spokesman Josh Earnest said U.S. President Barack Obama was confident of Frieden’s ability to lead the public health effort.

Read More: Texas Nurse

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Ebola ‘Breach of Protocol’. Is CDC Blaming the Victim?

The CDC claims a breach of protocol was responsible for a nurse in Dallas being infected with the Ebola virus. She was treating the man who died of Ebola. Let’s hope the CDC is correct and following the existing protocol exactly will prevent infection. But it’s possible the nurse followed protocol, but for Ebola the protocol needs to be reexamined.

If it was a breach of existing protocol the hospital and CDC may still be responsible. Apparently, the use of a supervisor or buddy system was not in the protocol. Doctors Without Borders always require someone watches every move a health worker makes when treating a patient infected with Ebola. Ebola is unforgiving. Any mistakes can lead to infection. A well trained supervisor  can catch mistakes and require immediate decontamination.

How Many Duncan Caregivers Are at Risk? ‘Breach of Protocol’

By Darrell Preston, Margaret Newkirk and Caroline Chen, Oct 13, 2014 8:14 AM ET

The U.S. health worker who contracted Ebola after being in contact with an infected patient in Dallas is leading officials to examine how widespread the danger is for those who cared for him.

Ebola virus danger sign with reflect and shadow on white background.

The unidentified employee at Texas Health Presbyterian Hospital wasn’t among the 48 people who were being watched because they may have been in contact with the patient before he was placed in isolation, said Thomas Frieden, director of the Centers for Disease Control and Prevention. Under the safety procedures in place, the caregivers were monitoring their own health.

“At some point there was a breach in protocol,” Frieden said at a press conference in Atlanta yesterday. “It is possible that other individuals were exposed.”

It’s the first time someone is known to have contracted Ebola inside U.S. borders, and only the second known case of an infection outside Africa. The diagnosis adds pressure on the U.S. government to tighten controls aimed at stemming the spread of the virus that’s killed more than 4,000 people this year in three African nations.

The Ebola Scourge

The health worker had been in contact with the patient, Thomas Eric Duncan, on multiple occasions, Frieden said.

The medical team members who helped care for Duncan once he was isolated at the hospital were responsible for monitoring their own conditions because they were considered to be at low risk, Frieden said. The infected worker noticed she had a fever, notified the hospital and was admitted on Oct. 10, Texas Health Presbyterian said in a statement. Her Ebola was confirmed by the Atlanta-based CDC yesterday.

CDC Investigates

The CDC will investigate how the lapse occurred while increasing training and safety procedures, Frieden said. Duncan died Oct. 8. He arrived from Liberia, one of the African nations being ravaged by Ebola, on Sept. 20 and didn’t begin showing signs of the disease until Sept. 24.

The infected worker, who has asked to remain anonymous, was involved in Duncan’s second visit to the hospital, said Dan Varga, chief clinical officer at Texas Health Presbyterian. The worker was wearing full protective gear, Varga said.

Protective gear doesn’t guarantee that an infection won’t occur, said Ashish Jha, professor of health policy at Harvard’s Public School of Health in Boston, in a telephone interview.

“The hard part is during the disrobing, when you take the suit off,” he said. “You’re removing material, getting skin exposed.”

Not Easy

The removal of the worker’s gear is one area being examined, Frieden said. “It’s not an easy thing to do right.”

Two other areas where the breach may have occurred are the respiratory intubation of Duncan and his kidney dialysis, Frieden said.

“Even a single inadvertent slip can result in contamination,” he said.

Health officials are assessing people the caregiver had contact with since she developed symptoms, and there has only been one who may have been with her while she could be contagious, Frieden said. That person is now under monitoring.

“We are broadening our team in Dallas and working with extreme diligence to prevent further spread,” David Lakey, commissioner of the Texas Department of State Health Services, said in a statement. The CDC has sent extra workers to help.

Complete story at: Breach of Protocol

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