Regular comment LAMH36 has volunteered to help us out:
So, with all this talk of Ebola and health care workers, of which I have been one for the past 10+ years, if ya’ll like, maybe you can put up a post concerning Ebola I would be willing to answer serious questions from commenters in the comments section to the best of my knowledge as an active Microbiology Medical Laboratory Scientist.
I don’t mind, and I plan to offer this to a few other blogs where I post. I figured when you have experienced knowledge about some subject, it always better to help spread factual information rather than allow misinformation to become embedded in the psyche.
Any questions, I cannot answer or that is outside my purview of knowledge, I can ask some of my other friends who are currently working in the hospital laboratory, CDC and beyond.
I’ve emailed her, and she decided that tomorrow, Monday evening, at 8pm EDT would be convenient. So I’ll put up a post then, and we can all get smarter about this topic together!
kc
That’s great, looking forward to it. Thank you, LAMH36!
MobiusKlein
Why are right-wing nutjobs so ignorant, and so unwilling to learn a thing?
And where are the FEMA death I mean internment camps located?
And when is it too late to close the borders to keep ISIS from sending terists from Mexico over the border to bleed on us?
Can I take the bus to work still?
When is it too late to panic?
eta:
I mean, thanks for being willing to share useful information with us.
scav
Yes! Many thanks. Time to go do our homework and think of those intelligent questions about quantum tunnelling and fume hoods.
jl
Seems like the start of the mess at hospital was a problem in the EMR workflow. That is an issue missing from the media discussions I have heard, and from my comments, since as soon as Presby Dallas goof became known I wanted an excuse to beat up on hospital chain operations (hey, I am human too).
I am getting a little out of my area here, but I been to seminars. The patient was not SOAPed correctly.Some of the initial S’s were left out in Status and Subjective statement of history by patient. Seems like travel is a basic when patient presents with infectious diseases symptoms. A couple of times I have gone to doc with weird digestive stuff that might be infectious disease, that lingers a little to long, and always asked for travel history.
I am sure this is hashed out in root cause analysis meetings at hospital. IIRC correctly, was problem with integration of doc and nurse EMR info flow. Doc couldn’t or wouldn’t or forgot to look at nurse notes.
At early stage, if anyone has seen all info flows, maybe would have noted problem. Simply noted something like ‘travel history?’ for example.
EMRs have their own problems and unique types of errors. Multiple windows open at once on screen cause wrong patient problems, and cheap and bad kluge is to limit number of windows open at once. Maybe doc was rushing and could not open another window?
So, wondering what is lamh36’s experience with EMRs and work and info flows and missing basic problems that should be caught early. It may be crucial in how the errors started cascading in the Ebola mess in Dallas.
Pogonip
Thank you,Lamh36!
Betty Cracker
Kudos to Lamh36 for volunteering to light a candle instead of cursing the darkness. My sense is that the diverse expertise resident on this blog should qualify us as a virtual civilization restarter should an extinction event ever befall the planet. If y’all ever need clarification on the utility of the subjunctive mood or require advice on how to nail down a dangling participal, please feel free to ask…Cervantes.
rikyrah
thanks lamh!
Another Holocene Human
@Pogonip: ditto
suzanne
This is rad. Thanks, lamh!
Dee Loralei
I appreciate Lamh doing this. Can’t wait to read it!
SiubhanDuinne
Thank you, lamh! I’ll probably be lurking rather than participating, but I expect to follow the thread with interest, and come away a good bit better-informed than I am now.
Somewhat on topic, and forgive me if this has been discussed — I’ve been obliged to spend more hours away from the blog than I’d prefer — but did anyone notice that as part of CNN’s big recent staff reduction measures they have cancelled Dr. Sanjay Gupta’s weekly medical show? (It’s unclear from what I’ve seen whether they’ve actually laid him off or if he will continue as a medical contributor.) It just seems odd to me that while CNN is in all-Ebola-all-the-time mode they would downsize the role of their resident medical expert.
Another Holocene Human
I actually have more questions about Enterovirus68 and mosquito-borne tropical diseases making it to Florida than Ebola. I feel like I know enough about Ebola right now for my needs.
I think we need a thread about why Nigeria is talked about in such condescending terms by the international press when it’s clear that (and should have been for a long time) that not everything about their government, infrastructure, society is a clusterfuck, especially given how they’re described by international news. Why is Texas talked about a certain way and Nigeria another?
Let’s just take a teeny tiny US example, so there has been some abuse within the Nigerian immigrant and/or expat community (having met a lot of Nigerians many of them would gladly return home if not for fear of violence or employment issues or other such factors) by ‘magical blackmailers’ if you will who extort money through threats of curses.
Look at the way this is talked about in the press and the condescension and jeering in the comments.
Then look at situations like that Texas pastor who convinced a mentally ill white woman to drown her children, or the televangelists and faith healers who extract cash out of disabled or elderly pensioners, or the culty weekend “power” seminars (Anthony Robbins and so on) who use torture and cult techniques to all but extort enormous sums of money out of their marks.
Usually the discourse is laced with anger towards these people and outrage that they would victimize such vulnerable people.
As if an immigrant far from home who may be very dependent upon immigrant community social networks and may be in fear of contacting US authorities is not also vulnerable.
Too many economically and socially privileged white people who become employed in entertainment and journalism (not as the on-air ‘talent’ although sometimes also them too but the editors, owners, columnists, writers, senior analysts, yadda yadda) think it’s cool to be racist especially if the targets of your stereotyping, disdain, and derision are dirty furriners.
mai naem
Here’s my question: Can the medical community come together in a conspiracy of sorts and push the meme that stupid people who don’t believe in science are not only more likely to get ebola but their incubation period is longer.
Okay seriously, there was a kind of suggestion the other night that the Dems can turn this ebola! lemons thing into lemonade by having blahhh wimmens go to teabagger voting precincts dressed up in the distinctive west african clothing – the mumu batik like kind of dresses with the head wraps. It’s kind of a Democratic voter suppression of teabaggers if you want to call it such. I think it’s an awesome idea and, really, this would be a really good investment of $50K by the DNC in west african clothing.
Josie
Thank you, lamh, for this generous offer. I will read this thread with great interest.
lamh36
Cool beans. Looking forward to tomorrow guys. I hope I can answer your questions.
And just so yall know the questions don’t have to only deal with Ebola. I know it’s in the news now, but on a regular basis there are plan ole common pathogens that I encounter every day as a Microbiologist that are more likely to infect you than Ebola.
So Ebola or not I’ll do the best I can to answer questions about the hospital lab and Microbiology.
see yall tomorrow
WaterGirl
@MobiusKlein: I guess you missed the phrase: “willing to answer serious questions from commenters”. :-)
Violet
Cool! Thanks for doing this! I see the lab worker who was on the cruise ship tested negative for Ebola so that’s good. Not a surprise but still good. I also saw a headline saying the cruise ship had docked in Dallas. Accuracy in reporting FTW!
trollhattan
@Violet:
Port of Denver was fogged in.
Debbie
@Violet:
Even though it’s impossible, I’d like it to be true. Glenn Beck was freaking out last week because God had told him to move to Dallas and he couldn’t figure out why. This might be a “sign” that’d push him right over the edge.
sharl
@lamh36: This is a great idea; thanks for offering to do this! I’m not optimistic about being able to follow the discussion in real time, but I’ll definitely be reading the thread whenever I am able.
I’ve been curious about the specifics of what constitutes “airborne transmission”. From the CDC’s Q-&-As on Transmission page for Ebola there is this:
That seems to be saying that transmission by aerosolised droplets* from a sneeze or cough isn’t likely, but is possible. From this my impression is that getting sneezed on directly by a person with full-blown Ebola is cause for immediate concern and action, while being on the other side of a large room when such a person sneezes is much less worrisome.
I’m curious about where the cross-over point might be. Inside an elevator maybe? I’m sure it all depends on virus fragility in the presence of oxygen, UV light (sun or fluorescent lamps), etc., in combination with aerosol size and viral loading of the aerosol droplets. [Presumably along with a bunch of other factorsI have no clue about.]
Do folks in your business have standard tests for quantifying this sort of thing? We do in the world of materials testing, but inanimate materials are much easier to work with than the kind of living matter you encounter.
Again, thanks! Looking forward to this.
*From the Epidemiology section of Wikipedia’s Sneeze page:
jl
@sharl: OK, not a doc or epidemiologist, but done economic analysis of infectious disease transmission.
Two things interact to make it very hard to control measles, flu, etc. airborne transmission and disease AND being infectious during later part of incubation period (no signs or symptoms) and prodromal stage (when general ‘feeling crummy’ sets in and specific signs and symptoms just developing). So infectious people walking around spreading the disease by air before it is humanly possible to ID them. Ebola does not seem to be at all easily transmissible during those periods. Need full blown symptomatic disease for Ebola to be easily transmissible through direct contact, which at that stage may include direct contact with sneeze droplets.
So, if a person who has had high fever for a while, bad vomiting and diarrhea with blood, profuse sweating, and can barely move, gets on a plane next to you, and sneezes, yeah, you might get the disease from the sneeze droplets. Are you terrified now?
Some gut viruses very hard to control because symptoms bad for most people, but disease is self limiting, and virus can survive for awhile on surfaces. So person plugs themselves up with kaopectate and can get through day, they leave a trail of virus particles lying around that people pick up and some get enough to get sick.
Some people can get flu with mild symptoms and they think it is a cold. They track virus around, it can survive on some surfaces for over a day, people pick that up and get in their eyes and noses (though mouth not as vulnerable) and get sick as hell.
I think focusing on one isolated aspect of disease spread can lead to misunderstandings.
Anyway, models of spread of disease, which is what I actually know, suggest very different patterns of transmission and difficulty of control, depending on interaction of several factors. Can’t focus just on one.
Origuy
H/T to Steve M:
jl
@Origuy: lets all quarantine ourselves for 21 days.
sharl
@jl: Thanks!
Indeed; that’s why information exchanges like these are useful (at least to me!).
MobiusKlein
@WaterGirl:
Ok, for my serious question,
What can I say to folks freaking out, asking stupid questions like what @MobiusKlein said?
jl
@MobiusKlein: Tell the ones who can read to grow up and educate themselves and quit saying stupid things in your face. Tell them to get off their fat asses and write the Congressperson to restore public health funding to the level supported by the progressive communist George effing W Bush, of all people.
Sorry, I am sick of living in a country of ignorant whiny cry babies.
How many thousands of people will flu, TB, hepatitis C, E coli from crummy food processing, and AIDS kill this year in this country? No panic about that, cause people used to it or think they won’t get it because ‘other peoples’ diseases.
suzanne
I will be busy tomorrow night, but I am curious about the four facilities that have the bio containment units. What do you know about the physical design of those facilities, and how is it different/better than a typical AII (airborne infection isolation) room/unit that most hospitals have? What about the labs? I presume copper instead of stainless steel worksurfaces, because copper actually kills stuff that stainless does not. Negative pressure? Anterooms? Epoxy surfaces? HEPA? 100% outside air? Anything else? I realize that you’re not a designer, but I would love more info if you have it to share.
Ripley
Great idea. Cole’s staying away then, right?