Category Archives: Epidemics

EBOLA FUCK UPS, CANADA AND DALLAS

imageYou heard it here first. If you read my earlier post https://thebrainsciencecritic.wordpress.com/2014/10/03/ebola-in-dallas-sars-in-toronto/   In Ontario we’re now hearing from the head of the Nurses Association and you can read the story http://globalnews.ca/news/1616000/potential-ebola-patient-horror-stories-in-canada-concern-nurse-union/?utm_source=Homegnca-toronto&utm_medium=MostPopular&utm_campaign=2014 about the lack of preparedness in our hospitals for an actual ebola patient. There have been some suspected cases, they’ve been reported on the news, with all kinds of happy talk about the person was put in isolation, blah, blah, blah. Now it turns out that at least one of them sat in the waiting room with seven other patients. For some period of time. That is exactly how isolation is NOT supposed to work. That is how the SARS epidemic happened. It spread in the emergency room waiting area. Nurses all over the country are reporting that they either don’t have the protective equipment, disposable plastic suits, gloves, special masks. Or they have it but it’s too small. But here’s the thing, if they’re finding out now that it’s too small that means they haven’t put it on before. There’s also mention in the above news story about “having seen the video”. That shows how to put on and take off the protective clothing. Now, what’s the protective clothing protecting you from? What it’s doing is making a barrier, think  barrier birth control, between the nurse or doctor and the person who has the virus. The virus is coming out of that person. So the medical personnel have to not just not get that virus on their skin, they have to not carry it out of the isolation room (remember isolation is just the new term for quarantine). The virus riding on their clothes then gets on the countertop and somebody leans on it and it’s on their arm and they scratch their arm and they touch their eye and  BOOM! they have ebola. That’s how it spreads. So once you are ready to leave the isolation room you have to do something with all this protective gear you’re wearing. The plastic suits are like coveralls. There’s a special way to take them off just like there’s a special way to take off plastic gloves. I don’t quite know what it is but you pull off one halfway, then pull off the second glove with your fingers still in the glove fingers of the first one. Is that clear? Yeah exactly, it’s fiddly and counterintuitive and complicated. Watching the video is not how you train medical personnel to do these procedures. There’s a whole academic specialty, Schools of Public Health, that deal with this stuff. We know what the correct procedures are. And if you actually intend to prevent disease spreading then you drill. Yes drill. Like pilots in flight simulators. But you don’t need fancy equipment you need a room, you need a doorway, you need the protective clothing. And you need the nurse and somebody shows the nurse how to do all this complicated suiting up and especially the unsuiting. Remember when you’re taking it off it’s shmutzy. It is presumed to have the deadly virus on it. So, special way to remove it. And the way you’re taught how to do something complicated like that, think of it on the same level as how to make a cheesecake or how to drive a car, the instructor watches you. So the instructor watches the nurse put on the special clothing, she pretends to do some patient care and then comes back and takes it off and the insrtuctor watches how she does everything and tells her when she’s doing it right and when she’s doing it wrong. Then she does it over and over and over again. Like firefighters. That’s what Mr. Singh in the Global news story (link at start of post) is referring to when he mentions muscle memory. It needs to become second nature to do each little movement in the exact right way. That’s training. Nothing else is. Watching a video is not training. The nurses in our hospitals have a friggin right to this. They may even have a legal right to it in their contracts with hospitals. And in Canada today our government is not doing it. The minister for health in Ontario went on TV and said some vague stuff about we are committed to doing the whatsit thing. This is what you say at the beginning of the planning process. We’re way after the planning process now. The planning process happened and the buying the stuff happened, in some hospitals in Toronto, but not in others in Nova Scotia. The handing out the equipment part has already happened. But it sucked. They buggered up. They didn’t train them the way I describe above. And the protective clothing doesn’t fit. Which is how I know that they didn’t drill. If they had drilled, and they were supposed to before the epidemic in Sierra fucking Leone even began, they would have found that out. It sounds from the reports that they found out the equipment didn’t fit ie didn’t work when they had a suspected ebola patient. Who ultimately tested negative, thank God. And not just for them. Because we are unprepared. It’s getting ready to be SARS all over again. 44 people died, over 100 were in intensive care. If everything had been done properly and again the textbooks tell how to do this, it ain’t rocket science. If everything had been done correctly two people would’ve died of SARS, not 44.

Ebola was discovered in the 1970s, I think 1976. We’ve had since then to prepare for this year’s epidemic. We knew it was coming. And we knew it was coming to North America on airplanes. Jet spread. I learned that term in the 90s. Right now this is idiotic, but it could easily become a disaster. And it will be a disaster born entirely of governmental incompetence, unwillingness to prepare in the proper way, and to a very great extent the fact that medicine is completely unregulated. Yeah the boneheads who screwed this up are not the ones who we would want to have regulating it. But it needs to be regulated. So that someone who has learned how you do infection control out of those wonderful textbooks would, with the authority of the government, go and check in advance that the hospitals were actually doing the stuff to be prepared. I mean for chrissakes the actual term for it is preparedness! But they didn’t get ready.

Hats off to the nurses and Nursing Association for blowing the whistle on this. Well done. Next time, do it sooner.

Let’s go to Dallas. So far two nurses who looked after the ebola patient in Dallas have contracted ebola. So yeah we’re a first world country and we don’t screw things up so bad. You catch ebola looking after an ebola patient by not keeping yourself fully covered 100% of the time that you’re in contact with their body or with stuff their bodily fluids have leaked out onto. Doing that and providing patient care is extremely difficult. And as a prize if you mess up even briefly, even a tiny bit, you get a potentially fatal disease. And you have to stop the epidemic by stopping the spread of the virus by doing everything in your job correctly. With absolutely zero mistakes. And when they do it right it works like magic. This is the only thing to stop the spread of infectious diseases. There’s no drug. There’s never a drug for these kind of diseases. Vaccines yes. But once the epidemic has started we need these excellent people to do this work. Stopping the epidemic with basically plastic sheeting. Sure it’s made into all kinds of stuff gloves and masks and those plastic jumpsuits. This, for all epidemic diseases, before a vaccine is created, is how they will be fought forever. This is the super expertise that our ancestors didn’t have. It doesn’t look like much, plastic sheeting, but it works.

You know what’s not as effective as plastic sheeting (made into clothes)? The CDC. Two nurses so far have contracted ebola at the Dallas hospital. One of them took a trip to Cleveland and when she was due to come home had a fever and called the CDC and asked if it was okay for her to fly and they said yes. The next day she was diagnosed with ebola. So more fuck ups. Now the flight crew has to be in quarantine for 21 days. The airplane is out of commission until they disinfect it. And there’s all the people who were on the airplane too. Now they get to be really really terrified. This is an example of the economic impact of an epidemic. When it’s screwed up. You have to put people in quarantine and then they can’t do their jobs, or be an airplane that flies around. This is costing the airline money. And it didn’t have to if the CDC hadn’t fucked up. They didn’t just guess wrong they didn’t follow the normal protocols. Err on the side of caution. Okay so two nurses caught ebola from Mr. Duncan, the now deceased ebola patient in Dallas. Another nurse there describes a “chaotic” scene when the ebola patient first arrived. I don’t know specifically what happened but I have to wonder if it’s like SARS. Where someone with a fever and clearly severely ill with an infectious disease arrives in the ER. They know that they’re supposed to put this person in isolation but there is no isolation room. Those went out with polio. So everyone freaks out and runs around. And during that whole time the patient is shedding virus. Preparedness means having isolation rooms that just sit there being isolation rooms when they’re not being used for that. The hospital administrators just will not get it through their heads that they need to do that. They need to be required by law to do that. They also need to have a separate entrance to the isolation area. During SARS a hospital in Western Canada where there was no SARS realized that they were not ready for fatal contagious diseases so they created a new doorway directly into their (newly created) isolation area. That’s what you do. There’s no shortcuts. During SARS in Singapore they took one of their hospitals and moved everybody out of it, and made it into their all SARS hospital. And the medical personnel wore moon suits. That’s slang for the kind that have their own air supply and look all puffy like you’re walking around inside a balloon. Those are the best kind. But even those you have to have special training and drill, to take them off safely. So that you don’t get the shmutz on the outside of them on your hands and then go put it on the countertop or the elevator button or in your eye. I dare say we shall hear more detail about how the Dallas hospital screwed up. To be fair the protective clothing that the CDC told them to get did not cover the nurses necks. That’s absolutely insane. As you can easily see based on what I said above. The shmutz is on your glove, you touch your neck, the shmutz is on your neck. The shmutz is the virus. That ain’t a moon suit. So when you see stories on the news with people saying “oh I’m much more afraid of the fear that of ebola itself”, snicker. It’s bullshit. You don’t need to panic about ebola, but you should be really pissed off at your government whether in the US or Canada for sucking so bad at this. Again, not rocket science.

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EBOLA In Dallas, SARS In Toronto

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First we hear there’s an Ebola case in Dallas. The man is in hospital, in isolation and everything is fine. Today, October 2 we hear when he first went to hospital he was turned away. And I thought oh my god it’s like Toronto.

In 2003 SARS hit Toronto. And everything fell apart. The first SARS case in hospital was the fortyish son of the elderly patient zero. She got it in China came back to Toronto, passed it to her son. And died. First screwup, she got a sign out autopsy. That’s where if you’re old and have multiple diseases when you die they don’t do an autopsy they just pick one of them and call that the cause of death. This is considered completely acceptable. So her son is in the emergency room coughing all over everybody the doctor he saw, an intensive care doctor, thought he had tuberculosis. Funny thing, tuberculosis is a reportable disease. To public health and you’re supposed to isolate the person. Like immediately. (Isolate means put the person in a room by themself where the air from that room can’t mingle with the air from the rest of the hospital. It’s very clever and it stops airborne diseases from spreading.) Did they isolate him? No, didn’t have the facilities to isolate people at that hospital. Because hey the age of epidemics is like over right? So he coughed on a guy named Pollock, Pollock then passes it to his wife and they both died.

Before people die from SARS they have trouble breathing so they get intubated, the people who do that are anesthesiologists. Anesthesiologists got sick with SARS and passed it to their family members and at least one anesthesiologist and his teenage daughter were both on respirators in the hospital. But did not die. An entire hospital Westpark IRCC was taken over for just nurses and doctors who were sick with SARS. A lot of people were on respirators all at once. This actually helped lots of places prepare for the and H1N1 outbreak in 09. They were ready with the respirators because they knew they might have to, and would be able to deal with, an epidemic of people needing help breathing. Please be aware, the hospital in your town does not have 30 respirators just sitting around in the basement. They may well have used them many during H1N1. They had to order them. That’s one good thing that came out of this and where people showed that they had their head screwed on right. During SARS, and planning for what came in 09.

Two family doctors died because patients were sick with a cough went to see the family doctor. The city didn’t have adequate protocols or places to put people with suspected SARS. No isolation rooms.

Except for Sunnybrook hospital, the major trauma center in Toronto. The guy in charge there as soon as he heard about the SARS thing rented compressor units that allowed him to turn regular rooms into isolation rooms. They’re called negative pressure rooms. They’re used in treating cancer too when the patients’ immune system is all buggered. In cancer they keep everybody else’s germs away from the cancer patient. They worked. None of the other hospitals did that. Not right away anyway. Two infectious disease doctors at another hospital both got SARS. They lived.

In an epidemic like this the public health department of the city government is one of the most important agencies in keeping it from being an even worse disaster. What a thrill. They are in charge of tracing contacts. Anybody who came into contact with the person who has in this case the respiratory-cough-the-germs-all-over the place disease. We’ve all heard about contact tracing when there’s an outbreak of foodborne illness. At a banquet or from a store. Whatever. This is a little more complicated. It’s some individual person’s trail through the city. Okay so public health departments did this all the time in the era of polio. They do it now for sexually transmitted diseases. The city of Toronto was completely unprepared. Their computer crashed. They were reduced to using tiny slips of paper with peoples names on being stuck into little charts on for floor. Well you might say nobody expected SARS. Everyone knew it was coming for a fact. They didn’t know what the disease would be but they knew that an epidemic like that and like Ebola now, was coming. They’ve had a name for it since at least the 90s and that name is jet spread. Okay you may say but if they didn’t know what disease was going to be spread by the jets then they couldn’t prepare for it. BULLSHIT. The way you fight epidemics of air- or sputum-borne diseases is with barriers. With the negative pressure room. With gowns and masks and gloves. It doesn’t matter what the microbe, the germ, is. What the microbe is matters for the drugs you give the person who is sick. But the keeping it from being spread is a whole other critter. They didn’t preplan they didn’t prepare they were fuck ups.

People were in quarantine, now it’s s called isolation in, their homes. They had suspected SARS and some of them did, some of them didn’t but nobody could tell until a certain period of time had passed. So they had to stay in their homes in a different room from the other people in it and wear masks. And they had to change the masks every so often and they had to take Their temperature. And they were checked on by an organization that was monitoring them, the Salvation Army? I think. Lots of quarantined people to monitor. They had to call in volunteers. Like during a hurricane or something. So that sounds pretty good right? And it would’ve been if they had been able to do it competently. They kept calling to check their temperatures of people who had already died of SARS. Competent planning, competent administrative stuff in a crisis would have completely prevented that. This stuff is doable. But you have to spend the time and money before the crisis to prepare for it. You do drills. They didn’t drill. Is that on the Salvation Army? It’s on the city of Toronto public health department. Let’s hope the Dallas one is more competent.

It gets better. The epidemic was slowing, maybe it had stopped. But with epidemics you have to wait until there have been no new cases for some period of time. Depending on the incubation period for the disease. Okay so one hospital in the north of Toronto said oh it’s over we’re going to stop doing our special procedures with the gowns and masks and gloves. We’re going to stop isolating people in the hospital who have pneumonia when we don’t yet know that it’s SARS. You know, the proper precautions. So they stop them. And there was a secondary outbreak of SARS in that hospital. Old people died who were in there to get joint replacements. Even though the outbreak was in a completely different ward. Why did it affect them. Weaker immune systems. That’s medicine 101. They had all the information they needed to do a good job. And this secondary outbreak was in the media for days before the goddamn hospital administration brought back the gowns and gloves and masks. Everyone knew what was going on and some idiot in charge managed to keep the right thing from being done for days or weeks. So elderly people in for joint replacements died. So did a young woman who was in having a fibroid removed from her uterus. Something you can wait six months or six years before you have done. Absolutely elective surgery. If the hospital had told her the truth about this possible SARS outbreak, that in fact was one, she was simply have had it done later and she would be alive today.

This is why the level of governmental that is in charge of fighting epidemics in our society can’t fuck up on every possible point.

Let’s just hope they don’t do this in Dallas.

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Filed under Bad hospitals, ebola, Epidemics, government, Medical Horrors, Medical mistakes, public health, SARS