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Thursday, October 16, 2014

Ebola and nurses

Nina Pham, R.N. - She is a young woman who had attended Catholic schools and who lives by the most fundamental Catholic principle, one that marks her kin in spirit with true heroes of all faiths and professions. “I want to help people,” she once explained.

Nurses earn licenses supporting their title as "Registered Nurses". One of the responsibilities of carrying the R.N. title is to protect the public from harm. Therefore, kudos to Dallas Texas nurse Briana Aguirre who alerted the nation on national news about how ill prepared Texas Health Presbyterian hospital was when Mr. Thomas Eric Duncan presented in the emergency department with symptoms and travel history consistent with Ebola.  

Mr. Duncan later died of the deadly Ebola virus, in spite of heroic efforts to save his life following the error in judgement made by Texas Presbyterian to send him home after his first visit to the emergency department, where he came presenting with a fever.  

As a result of this error, Mr. Duncan returned by ambulance to the same emergency department with even more acute symptoms and exposed dozens of people to the Ebola virus.

Texas Health Presbyterian Hospital nurse Briana Aguirre, who cared for her friend and co-worker Nina Pham after she tested positive for the Ebola virus, says she can no longer defend her hospital over how she claims it responded to the disease, after Thomas Eric Duncan arrived.

“I watched them violate basic principles of nursing," Aguirre told TODAY's Matt Lauer in an exclusive interview that aired Thursday. "I would try anything and everything to refuse to go there to be treated. I would feel at risk by going there. If I don’t actually have Ebola, I may contract it there," she said. 

Well, there you have it......Texas Presbyterian will probably never be able to overcome the stigma of being ground zero for three Ebola infections.  Mr. Duncan arrived with a high viral load of the Ebola virus in his blood.  As a result, his infection somehow passed through the barriers and protocols used by two nurses who treated him, causing them to become ill with the Ebola virus. Three patients from one hospital!  Ms. Aguirre is absolutely correct. 

Look at it this way, if Texas Presbyterian made three medical errors leading to the deaths of a trio of surgical patients, all in a cluster of less than two weeks, the Texas health department would be conducting a sentinel event survey....or should.  I'm pretty sure Texas Presbyterian hospital corridors resemble haunted tunnels where few patients and only a skeleton staff are holding operations together in the face of all this horrific Ebola news.

Meanwhile, nurses are now suffering as a result of being the caregivers for one Ebola patient. The Dailey Beast is reporting how Ebola nurses are as brave as soldiers.

The nurses fighting to contain Ebola at Texas Presbyterian have shown uncommon courage, even as their work puts them at the greatest risk for infection.

By comparing the work schedules of the two Texas nurses who have been diagnosed with Ebola, medical detectives have narrowed down when they were most likely infected.

Nina Pham and Amber Joy Vinson were both treating Thomas Duncan during the days between his Sept. 28 admission to the Texas Health Presbyterian Hospital and the subsequent confirmation that he did indeed have Ebola.

And, according to an anonymous statement apparently issued by some of their co-workers, this was the same period of time before the hospital instituted adequate precautions.

“Our investigations increasingly suggest that the first several days before the patient was diagnosed, appear to be the highest risk period,” says Dr. Thomas Freidan, director of the federal Centers for Disease Control and Prevention. “That was the 28th, 29th, and 30th. These two health-care workers both worked on those days and both had extensive contact with the patient when the patient had extensive production of body fluids because of vomiting and diarrhea.”

But that is still only supposition. What is uncontestable is that 26-year-old Pham and 29-year-old Vinson and all the other nurses who treated Duncan were uncommonly brave.

As an Ebola patient slips from bad to worse to dire, he can expel as many as two and a half gallons of effluvia a day. A single drop of his blood can hold nearly a half billion viral particles, some 50,000 times more than with untreated HIV—math that makes Ebola at this stage so much more contagious.

Yet the nurses kept giving their all to save Duncan, fighting to keep their patient hydrated as he geysered it back out as hyper-hazardous waste.

They did so knowing that each time they inserted a needle or cleaned him or simply adjusted him in the bed they risked sharing his fate. His very skin would have had high levels of Ebola.

The specter of this virus fills some of our most stalwart souls with unreasoning dread even when it is no immediate threat. Soldiers of the 101st Airborne at Fort Campbell, Kentucky, who have faced IEDs in Afghanistan and Iraq, say they are more apprehensive about being deployed to Liberia. This, despite assurances that they will not be in contact with Ebola victims and therefore run minimal risk of infection. They can only be grateful to be equipped and trained with full body hazmat suits complete with hooded face masks.

Too bad the courageous nurses in Texas were not similarly trained and equipped before Liberia and Ebola came to them in the person of Duncan. They did the best they were able to do with what they had and what they knew as this Texas hospital was suddenly on the frontline of the war against Ebola.

The threat of this virus to the general public may have been exaggerated. But the dangers faced by those who work with its victims has not been fully appreciated even by some hospital administrators. Nobody is more heroic than Ebola nurses; not soldiers, not cops, not firefighters.

And none of the nurses was more meticulous or caring than 26-year-old Pham. She once told a friend that she asks herself a question when treating a patient.

“What would I do if this was my mom, dad, or grandparent?”

Not even the most careful care could stop the virus and all the nurses’ efforts ended in Duncan suffering a harrowing death. The nurses were then left to worry if they had themselves become infected. They were told to continue to monitor themselves for symptoms and take their temperature twice a day for 21 days.

On Oct. 10, two days after Duncan’s death, Pham saw that she had a low-grade fever. She immediately drove herself to the hospital, placing nobody at risk.

By several accounts, Pham remained her usual buoyant self as she began her own struggle with Ebola in the same facility where her patient had just died. She is a young woman who had attended Catholic schools and who lives by the most fundamental Catholic principle, one that marks her kin in spirit with true heroes of all faiths and professions.

“I want to help people,” she once explained.

She now issued a public statement, but she did not join the complaints about the hospital that other nurses had lodged anonymously.

“I’m doing well and want to thank everyone for their kind wishes and prayers,” she said. “I am blessed by the support of family and friends and am blessed to be cared for by the best team of doctors and nurses in the world.”

Everybody was hoping that she was not just in a stage during the first few days when some Ebola patients seem hardly ill, but then suddenly crash. She received a transfusion as well as a dash of hope from Dr. Kent Brantly, an Ebola survivor who had himself received a transfusion from a teenage survivor when he was battling the virus in Liberia.

The continuing mystery was how the meticulous and careful Pham had become infected. The CDC initially suggested that she had somehow broken protocol, but quickly reconsidered when it became clear that an appropriate protocol had not been established at the outset. There was also the question of inadequate protective gear and insufficient instruction.

But there was still no clear answer as to exactly how Pham had gotten ill. And this meant that the nurses who now cared for her had no way of being sure they were safe. They still did not hesitate to do all they could. And the CDC team that arrived to ensure they were properly trained and equipped found them in no need of moxie and dedication.

“They’re all tired. They’re stressed because they all think ‘Maybe I’m the next one,’” Dr. Pierre Rollin of the CDC told a Dallas TV station. “But they’re all willing to work. They’re all volunteers. They’re not forced to come to help; they want to do it.”

The weekend following Duncan’s death, Vinson visited her mother and her fiancé in Ohio to plan her wedding. She took her temperature on Monday and noted it was slightly elevated to 99.5, just under the threshold for worry.

She went ahead and flew on Frontier Flight 1143 from Cleveland back to Dallas. The CDC would later suggest that she should not have boarded a commercial plane at all until 21 days past her last exposure to Duncan. But she reportedly called the CDC before she flew and was given an OK because the fever so close to normal and she posed no threat unless she was showing symptoms. And it should not be forgotten that the CDC had vetted a video message by President Obama last week that a person “cannot get Ebola through casual contact like sitting next to someone on a bus.”

On Tuesday, Vinson saw that her temperature had risen above 100. She was soon after at the hospital with Pham. Dallas County Judge Clay Jackson praised Vinson’s “grit, grace, and determination.”

“Like Nina Pham, she is a heroic person—a person who has dedicated her life to helping others,” he told a press conference.

The CDC reported that even though the risk was minimal for those who had been aboard the plane with Vinson, it was tracking down the passengers and crew out of an abundance of caution.

“We think there is an extremely low likelihood that anyone who traveled on this plane would have been exposed, but we’re putting into place extra margins of safety and that’s why we’re contacting everyone who was on that flight,” Frieden said.

Pham remained at the Texas hospital as preparations were made to transfer Vinson to Emory Hospital in Georgia, which has a highly regarded infectious-disease facility that successfully treated Brantly.

Vinson was rolled out in a wheelchair wearing a full body hazmat suit. Such gear might have protected her from being infected in the first place during those initial days when she and Pham and the others selflessly fought to save Duncan.

Now Pham and Vinson have Ebola and are in the care of nurses as brave as themselves.

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