Non-ebola care
September 23, 2014 12:47 PM   Subscribe

As hospitals struggle to cope with the ebola epidemic, where are patients with other emergencies finding care? In Monrovia, Liberia, it's Cooper Adventist Hospital. Without proper isolation facilities to handle ebola, they are instead tackling everything else. This August 17, 2014 San Bernardino Sun article discusses the challenges the doctors are facing. Dr. James Appel's blog (Dr. Gillian Seton's article appears in the side bar), and his recent remarks on international aid efforts.
posted by probably not that Karen Blair (56 comments total) 16 users marked this as a favorite
 


I was just working on a post to round out these two articles - why are affected West African states so spectacularly ill-prepared to deal with Ebola, and to live and die with Ebola in Liberia.
posted by ChuraChura at 1:28 PM on September 23, 2014 [4 favorites]


I was working on a post about this as well....glad someone else did it much better than I could. This is so frightening...... I hope the international community joins in to aid these people....
posted by pearlybob at 1:31 PM on September 23, 2014


Sorry, probably not that Karen Blair, my head was so full of those articles tonight that I didn't notice you were trying to draw attention to the effects of the Ebola crisis on non-Ebola care. Also a major concern.
posted by rory at 1:33 PM on September 23, 2014


Math is fun, at the current rate of growth the entire world will have ebola within 21 months.

I know it won't work out that way, western medicine, hygiene, differing behaviors, but still...
posted by Cosine at 1:34 PM on September 23, 2014


I know it won't work out that way

But one really scary point I've seen is that now that there are a volume of cases the possibility of more infectious with more liberal vectors. The only element that seemed at all positive is that the nature of the bug makes it less likely to become airborne.
posted by sammyo at 1:49 PM on September 23, 2014 [1 favorite]


I have a lot of Western African students (here in West Philly-ish), and their families are hearing all about it. They are very scared, obviously.
posted by angrycat at 1:49 PM on September 23, 2014


I know it won't work out that way, western medicine, hygiene, differing behaviors, but still...

Yeah, except:

The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did in 2009, after its birth in Mexico.

Why are public officials afraid to discuss this? They don’t want to be accused of screaming “Fire!” in a crowded theater — as I’m sure some will accuse me of doing. But the risk is real, and until we consider it, the world will not be prepared to do what is necessary to end the epidemic.


One of these days, we're going to lose that dice roll.
posted by longdaysjourney at 1:58 PM on September 23, 2014 [3 favorites]


WaPo had a story this week about how more people could die of Measels, apendicitis, failed births, etc, than Ebola would kill because of the total colapse of the normal health care system in afflicted countries.
posted by fontophilic at 1:59 PM on September 23, 2014 [2 favorites]


Apologies - meant to link to the source of that quote:

What We’re Afraid to Say About Ebola
posted by longdaysjourney at 2:05 PM on September 23, 2014


The worst thing I have seen recently is that "The West has to do something because the disease is mutating and may become airborne and spark a global pandemic. Therefore we must do something!"

No, we in the West need to do something because several countries in West Africa are facing collapse because their healthcare systems are being annihilated, as are their economies.
posted by Nevin at 2:14 PM on September 23, 2014 [8 favorites]


I don't particularly care why we provide aid, as long as we provide aid. If it takes selfish self-interest as opposed to humanitarian motivations to force us to do something, I'm ok with that at this point.
posted by longdaysjourney at 2:28 PM on September 23, 2014 [2 favorites]


Ebola was terrifying when I thought it had a six hour incubation period.

With eighteen days between exposure and symptoms, at this point I feel like all bets are off, even the current strains never regain the airborne transmission Reston ebolavirus demonstrated.

On the plus side it's done wonders for my hand washing diligence recently.
posted by hobo gitano de queretaro at 2:42 PM on September 23, 2014


If you want the real thing to worry about, it is this. With a disease being widespread it will select for silent carriers.
posted by dances_with_sneetches at 3:26 PM on September 23, 2014


I don't see how you keep 1.4 million people in west Africa. They need to shut down the airports yesterday. If it gets to Brazil, we can kiss all our asses goodbye.
posted by empath at 4:31 PM on September 23, 2014




Empath, ebola only spreads as far as humans will take it.

Let's say you cut off all travel and thereby trade in a country. You guarantee people will not be able to get food. You develop black markets for food and mobility for those traders. People will go where food is and ebola will follow. This is why the WHO does not want travel restrictions.
posted by fontophilic at 7:03 PM on September 23, 2014 [1 favorite]


A virologist's response to that Osterholm op-ed with the "oh noes airborne" panic in it. I respect Dr. Osterholm deeply as an epidemiologist and policy-maker but I think he misstepped there - this epidemic is bad enough and worsening fast enough without entering the realm of unlikely what-ifs. We need to be scared, more scared than we are, but we don't need to be scared of the unlikely. We need to be scared of exactly where we are, and where it's likely to take us. Dr. Tara Smith has a more measured but equally terrifying summary of where we stand.
posted by gingerest at 8:40 PM on September 23, 2014 [3 favorites]


I think it was in the previous thread, a link to a TED talk (probably) about the human mind's inability to appreciate exponential growth. I keep thinking that's where we are with regards to Ebola: because car accidents have, over the same time period, killed more people we assume (or under-estimate) that Ebola will be taken care of and go away. We can't wrap our brains around the fact that if we don't deal with this right now the chance of this blowing up extravagantly are large. And then a lot of people die. And not just in Africa. And with a little genetic mutating, people could be keeling over all over the world.

With that cheery thought, I'm getting back to work.
posted by From Bklyn at 11:45 PM on September 23, 2014 [2 favorites]


James Appel's blog is sobering reading, and I've only read the 11 and 12 September entries. Doing this kind of work in the context of an Ebola outbreak is just as heroic as working directly with known Ebola patients, given the amount of bodily fluids involved.

Oh god, the 5 September entry is horrific...
posted by rory at 5:14 AM on September 24, 2014 [1 favorite]


(Sorry, those entry permalinks don't work; the blog seems to be compiled from Facebook posts, and they've left in the links to private entries.)
posted by rory at 5:25 AM on September 24, 2014


We can't wrap our brains around the fact that if we don't deal with this right now the chance of this blowing up extravagantly are large.

I don't understand what 'dealing with it' would entail. I don't see how this gets stopped, sort of everyone staying in their homes for a month.
posted by empath at 7:08 AM on September 24, 2014


CONSERVATIVE BIBLE THUMPER RECOMMENDS NUKING AFRICA in 3, 2, 1...
posted by quonsar II: smock fishpants and the temple of foon at 10:01 AM on September 24, 2014 [2 favorites]


I don't understand what 'dealing with it' would entail. I don't see how this gets stopped, sort of everyone staying in their homes for a month.

Theoretically, could this be arranged? I know none of the governments in West Africa have the ability, but with global assistance, could the aid infrastructure be put in place to essentially shut down a society for a given period of time? You'd have to have like, door to door food delivery and stuff.
posted by Ray Walston, Luck Dragon at 10:48 AM on September 24, 2014


Theoretically, could this be arranged?

Why not try it in your town, first? Then let us know how you get on?
posted by Mister Bijou at 11:06 AM on September 24, 2014


ok let's theoretically do it in my town first
posted by Ray Walston, Luck Dragon at 11:30 AM on September 24, 2014


Everyone should take a look at the actual CDC report.

"In a hypothetical scenario, the epidemic begins to decrease and eventually end if approximately 70% of persons with Ebola are in medical care facilities or Ebola treatment units (ETUs) or, when these settings are at capacity, in a non-ETU setting such that there is a reduced risk for disease transmission (including safe burial when needed). In another hypothetical scenario, every 30-day delay in increasing the percentage of patients in ETUs to 70% was associated with an approximate tripling in the number of daily cases that occur at the peak of the epidemic (however, the epidemic still eventually ends). Officials have developed a plan to rapidly increase ETU capacities and also are developing innovative methods that can be quickly scaled up to isolate patients in non-ETU settings in a way that can help disrupt Ebola transmission in communities. The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely."
posted by showbiz_liz at 11:38 AM on September 24, 2014 [6 favorites]


The CDC are pretty unlikely to publish a report saying that there's no hope.
posted by empath at 11:41 AM on September 24, 2014


Ok, fine, it's all a lie, no one can do anything, and the world is doomed. Go ahead and cash out that 401k. Fuck that guy you've had your eye on, quit your job, and go on a crime spree.
posted by showbiz_liz at 11:43 AM on September 24, 2014


How the U.S. Screwed Up in the Fight Against Ebola - pretty good article. Although the inclusion of Bloomberg's "RedRum" magazine cover is a bit dramatic and contributes to the heightened anxiety surrrounding this topic.
posted by joseph conrad is fully awesome at 2:31 PM on September 24, 2014


A microbiologist friend of mine has been beating the "this ebola outbreak is some serious scary shit" drum for the past few months. I thought he was being dramatic, but it's pretty clear he was spot on and I was being pretty naive. It's not surprising tho, we've been hearing about SARS, bird flu, swine flu and they've been fairly mild, especially in the west. Guess I need to start paying attention when microbiologists are talking.
posted by [insert clever name here] at 3:19 PM on September 24, 2014


Does anyone have permission to view this interactive graphic?

http://www.nejm.org/doi/full/10.1056/NEJMp1410741 (New England Journal of Medicine)

I'm curious what it shows and how useful it may be.
posted by joseph conrad is fully awesome at 4:02 PM on September 24, 2014


I don't understand what 'dealing with it' would entail. I don't see how this gets stopped, sort of everyone staying in their homes for a month.

The transmission of Ebola must be curbed. The only way to do this is to isolate infected people during the final stage when the disease is most transmissible.

At this time, the rudimentary health systems in several west African countries have collapsed. There is no care for people with the disease, and no ability to quarantine. As a result there are people with Ebola walking the streets of their communities, searching for help.

The disease is transmitted via bodily fluids. So these people are either defecating in the street, or they are defecating at home. Either way they pass the disease on to other people, who continue to pass on the disease.

At the very least, the West must pour resources into west Africa to rehabilitate the medical systems. It may not stop the disease in its tracks, but repairing the medical system can help slow the exponential spread of the disease.

As I said upthread, the immediate threat is not that the disease will spread to a rich country; the threat is that the disease will destroy several countries in West Africa.

That's a big deal, and intrinsically worth trying to stop.
posted by Nevin at 4:10 PM on September 24, 2014 [3 favorites]


Here's Dr. Appel's blog, non Facebook style. Woh. http://www.ahiglobal.org/main/news/?title=ahi-doctor-heads-to-liberia-to-aid-ebola-crisis--james-appels-personal-log-of-daily-events/


posted by beckybakeroo at 6:47 PM on September 24, 2014


The One Simple But Crucial Technology Overlooked In The Fight Against Ebola (Forbes - basically, the vaccines must be kept cold - there is no infrastructure to meet this requirement)
posted by joseph conrad is fully awesome at 8:17 AM on September 25, 2014


Only slightly off topic:

A symphysiotomy is basically ripping apart the pelvis right? How is this ethical to perform on a woman delivering a dead child? I get that cesarean isn't always an easy option in those settings, and a procedure that is destructive to the head of the fetus can't be trivially undertaken, but seems more humane, and then I'm reminded that this is a missionary hospital...
posted by fontophilic at 11:06 AM on September 25, 2014


A symphysiotomy is basically ripping apart the pelvis right?

In natural childbirth, the bones of the pelvis will part at the pubic symphysis in order to make more room for the baby. You can actually tell by looking at the bones of a human women whether she has given birth or not, because the surface where those bones meet will be ripply-looking from being separated. So a symphysiotomy is actually much more similar to natural childbirth than a C-section. It involves a smaller surgical wound through fewer layers of tissue, and the uterus doesn't have to be cut into at all. Apparently it also lowers the risk of complications for future births compared to a C-section.

Here's an article you may be interested in. "Comparing symphysiotomies to CSs in circumstances that are now only present in developing countries, Björklund found that: maternal mortality is much lower with symphysiotomies; the short-term complications are less serious; and babies do not do worse as a result of symphysiotomy."
posted by showbiz_liz at 11:47 AM on September 25, 2014


In other words, just because this guy is a Christian doctor doesn't mean he's in the business of ripping women apart with his bare hands just for jollies.
posted by showbiz_liz at 11:53 AM on September 25, 2014


You need an anesthesiologist to perform a C-section safely. You don't to perform a symphysiotomy.
posted by gingerest at 2:12 PM on September 25, 2014 [1 favorite]


And from what I gather, fetal destructive procedures carry more risk to the mother than symphysiotomy, but remain an option after symphysiotomy.
posted by gingerest at 2:33 PM on September 25, 2014


First american case
posted by empath at 2:04 PM on September 30, 2014


Don't panic, we got this.
posted by gingerest at 10:27 PM on September 30, 2014


A West African student of mine just returned from his home county. Three of his family died from ebola.
posted by angrycat at 9:25 AM on October 1, 2014




Ebola swamps a city in Sierra Leone.
posted by rory at 1:59 AM on October 2, 2014


The NYTimes article rory links to above should be read.
posted by From Bklyn at 8:38 PM on October 2, 2014 [1 favorite]


First case contracted outside Africa

I think this outbreak is more contagious than the authorities believe it is. I don't think that health-workers are going to be prepared to treat it, or be willing to treat it. I don't think it's going to be contained. I don't think it's unreasonable to start making preparations for a pandemic.
posted by empath at 2:43 PM on October 6, 2014


There is no risk here that hasn't previously been identified - public health authorities have said all along that providing care is one of the principal risks for Ebola, and that the primary means of transmission is direct contact with people and their body fluids. This case is wholly consistent with that.

Do you encourage your friends and family to get their flu shots every year? Wash your hands for at least 15 seconds after you use the restroom and before you eat or drink or smoke, every single time? Cover your mouth when you sneeze or cough, and teach your children to do the same? Vote consistently against lawmakers who cut public health funding? Call your lawmakers to encourage them to support public health funding and research? Those are the most important individual preparations for a pandemic, and you should be doing them already, because lethal infectious disease is not a new threat. They're not sexy or dramatic, but they work great if you take them seriously.
posted by gingerest at 5:57 PM on October 6, 2014 [1 favorite]








The protocols work perfectly. We just need everyone to be perfect and it'll all be fine.
posted by empath at 4:02 PM on October 12, 2014


Generally speaking, infection control protocols have some redundancy built into them so that people don't have to be perfect. For treating Ebola patients, CDC recommends contact and droplet precautions, protocols big tertiary care facilities use regularly with patients who require isolation for more common pathogens. No protocol is perfect, and administrative support makes a big difference in how well isolation works.
posted by gingerest at 8:10 PM on October 12, 2014


Wherever I turn, there is Ebola. In the newspapers and magazines, on television and radio, and across the ubiquitous social media. Ebola. I sweat, shake, and cringe in mortal fear. Such an ugly word, fearsome in its primal sound, so African, so dark, so black.
posted by ChuraChura at 6:10 AM on October 13, 2014


Pertinent article from Scientific American.
posted by From Bklyn at 1:16 AM on October 14, 2014


The comments in that SA article are really good, btw.
posted by empath at 7:23 AM on October 14, 2014


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