Ebola: Health care worker tests positive at Texas hospital | Hacker News Reader

Ebola: Health care worker tests positive at Texas hospital

bbc.com

38 pointsadventured21 comments

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.

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).

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?

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.

Either case, it's a big problem. In the west too.

"It is not clear whether the health worker who tested positive came into contact with Mr Duncan when he first showed possible symptoms or when he was re-admitted to hospital."

I suspect they where infected before Duncan was known to have Ebola. There are two ways to suppress transmission, treat everyone as if they where infectious or isolate people before they become infectious. Unfortunatly it's simply a numbers game on average does someone infect more or less than 1 person.

You suspect, but you don't know. The Spanish nurse was infected while she was treating a patient known to have Ebola.

Regardless, one thing is clear - this strain of Ebola is far more contagious than earlier strains, and it still falls about in the middle of the normal range in terms of lethality (20% - 80%). If this genie gets out of the bottle it's going to be really bad.

EDIT: At the press conference they said the person was wearing protective gear in all contact with the patient, which seems to me like it would have to be after he tested positive.

My understanding was that she was infected from touching her eyes shortly after decontamination.

I've had really bad allergies for the past few weeks, and have involuntarily rubbed my eyes so many times in that period, I empathize with this a lot.

This was said a few comments up:

> 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).

Humans are fallible. I do stuff that I intellectually know is stupid all the time, and those are conscious decisions, not even borderline-reflexive ones like touching your face if there's a random itch.

I do stupidish things too - but I don't work with _ebola_.

So far there have been 3 US patients that have infected 1 person that's bad, but no real reason to panic. The real risk is if the number of new infections is greater than the number of existing cases.

There has to be a middle ground between the blasé attitude US authorities are taking and panic.

What makes you think it's blasé? I'm not an American, but from what I've seen from here in Australia your government appears to be taking it seriously, and straddling that middle ground rather well.

From the article, "But despite telling medical staff he had been in Liberia, he was sent home with painkillers and antibiotics."

I think it's probably a fair suspicion in this case.

I've read that variously as "Liberia" and "West Africa", and of course the hospital has so far changed its official story once. I suspect the truth will only come out in the almost inevitable litigation, if at all.

In recent decade, we had few years without a fear for an apocalyptic virus spreading a deadly disease. I suspect it shows the success of our detection, classification and diagnosing techniques for the specific virus lines. But one can't help but ask; is this the big one?

It's may end up being bad, but I doubt it. The incubation period is relatively short, so quarantine will be effective once we get serious.

Now, take a virus like this one, add a 30 day incubation period where you're asymptomatic and contagious... that would be the big one. Make it airborne and we're in The Stand territory.

Since you can, supposedly (I don't really trust all the information we have been given) only infect others once you have shown symptoms yourself and the infection is only partially persistent in the environment (how long I don't know, but they did remove some of the items that Duncan came into contact with) and not actually airborne it doesn't seem to be a good candidate.

Is this the "big one"?

As in a widespread, prevalent, worldwide pandemic that also affects the United States in a widespread manner? Dead people in the streets in the USA? It doesn't appear that way to me because ebola doesn't appear to be incredibly easy to transmit compared to other "big one" infectious diseases humanity has dealt with in the past.

For example, if it was vastly contagious, I'd think someone in Thomas Eric Duncan's extended family would have caught it. Out of all those exposed, none of them caught it including his fiancé.

And this was a guy apparently sent home from the hospital showing symptoms with a 103 degree temperature, etc. - witnesses also said he was vomiting profusely "all over the place" (even outdoors in front of his housing complex).

No doubt this is a serious, devastating issue and may very well affect millions in developing countries if no improvement in intervention and community behavior occurs. Properly educating health care providers and the public is paramount. I also think it's likely to spread somewhat in the USA, but not anywhere near compared to developing countries.

I think it's overhyped in the media and that's good - and bad. The good is the overhype will lead to more media exposure and perhaps preventative measures being demanded by the public to better prevent the spread.

Reminds me a little of the Y2K bug. There was a media hyped freakout over it, so a lot of people became aware of the issue, took precautions/actions and prevented the worst case scenarios from happening. New Years Day for 2000 went mostly without a hitch for the general public. The "overhype" in that case worked in our favor to some extent and prodded people to take action due to so much media exposure.

However, the bad from the CNN-esque overhype in this particular case is that irrational fear may very well get in the way of proper responses and cause ebola to spread more widely in developing countries than it would with a more balanced and less hysterical approach. So, I do think the overhype may very well be a double-edged sword in that regard.

I'm somewhat surprised, but not shocked, that a health care worker caught it from Duncan in Texas even while (apparently) wearing protection, etc. - but I also have a feeling some protocol, somewhere was missed. I would hope it's all on hospital surveillance video and people are checking the footage very carefully to see if they can spot any lapses in said protocols. If they aren't using comprehensive surveillance of people working with ebola in American hospitals - then they really need to start, in my opinion.

I've seen plenty of nurses in American hospitals go from room to room tracking potential contaminants on the bottoms of their shoes because they often don't wear disposable booties. Meanwhile, they inevitably drop items on the potentially contaminated floors and often don't replace or even just clean the items. Especially those pulse oximeters that easily fall off fingers onto the floor and also have cords that often touch the floor as well and end up being touched one way or another afterwards without being cleaned/replaced. There's also an issue where nurses and doctors simply don't wash their hands enough.

After witnessing this, I'm not shocked someone caught ebola in that Texas hospital. Like I said, I strongly suspect some protocol was missed even if the administrators initially claim all protocols were properly followed.

In my opinion, this is a very serious issue and our hospitals have needed a wake-up call for a long time to better prevent transmission of infectious diseases in hospitals. But, I'm not seeing this leading to a "big one" within the USA. If anything, I think it may be beneficial in finally getting more American hospitals to finally clean up their act and help to prevent less scary infectious diseases down the road.

Good breakdown and comparisons with other contagious diseases here:

http://www.webmd.com/news/20140806/ebola-virus-how-contagiou...

Containment is possible, but very resource intensive for facilities, staffing, and supplies. If it begins to spread significantly the system will get maxed out quite fast, and then an alternate form of containment will likely become necessary.

If its so hard to protect health workers against something like Ebola I wonder how we'll cope once the "big one" inevitably hits.

Monkeys placed together in the same room, but in different cages (that are outside any touching distance of each other) all get Ebola if one monkey is infected - due to any type of cough producing airborne droplets of fluid that are them inhaled by everyone in that room.

All you have to do to get Ebola is walk near the area that an infected person sneezed in, at some point in time shortly afterwards, or be in a confined space with him/her.

I've developed an unbelievably controversial point of view of this mess: the aid agencies acting in Africa are part of the problem. Simplistically, they've enabled the survivability to creep up to a point where the disease can now spread enough to infect a lot more people.

Until there is less squeamishness about quarantining around infected areas this mess will grow and grow. It is deeply disturbing to see just how thin the veneer of disciplined logic that supports civilisation actually is.

Maybe that's controversial because it's wrong?

One of the major hurdles this ebola outbreak presents is the fact that it is now spreading through much more heavily populated west Africa, a place that has never known Ebola, and does not have the public health infrastructure to deal with the disease.

Most Ebola outbreaks have taken place in central Africa, and usually in relatively remote locations.

It's frustrating to hear conjecture like this because it elides so much confused or incorrect information into a jumbled mess. Africa is a huge and diverse place just like any other continent.

Africa may be diverse, but the areas that have been hit are just as poor as you would expect when you hear the word Africa.

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