Governor Rick Perry is not responding to the Dallas health response to Ebola outbreak

Given the extraordinary media attention justifiably being swarmed on Dallas and the Texas Health Presbyterian hospital's admitted wrong response to the city's Ebola outbreak, it seems odd not to be hearing from the state's Governor Rick Perry. It just seems like the governor's leadership should offer condolences to the victims of this horrible Ebola outbreak in Dallas and provide support for Texans in the form of assurance about the state's public health response to the situation. Instead, the situation of "horribles" is  floundering from bad to worse and the end is not yet in sight.  

In another 21 days, the longest incubation period of the Ebola virus, the nation will either have an end to the outbreaks of person to person spread of the disease or not. Hopefully, the second American nurse, who inappropriately traveled with a fever after she cared for the now deceased Mr. Duncan, the Liberian man who died from the virus at Texas Health Presbyterian, has  not infected any others.  Nevertheless, the chances of others becoming ill with Ebola, as a result of the Texas Health Presbyterian blunders, including not monitoring the nurse who wrongfully traveled, raises the risk of more infections.

News media aren't asking for a statement from Governor Rick Perry. Yet, when Hispanic innocent children from Central America were detained in Texas, the governor was front and center with criticism about the state's border security. Now, the governor is apparently speechless about a deadly infection brought to Dallas from a visitor who should have been screened for the Ebola virus when he presented with a fever at Texas Presbyterian. Instead, the patient was sent home, where his illness exacerbated, and he exposed countless others to the virus now causing panic about who is at risk for being the next victim. 

This Ebola outbreak in Dallas didn't arise from immigrant refugee children who  were fleeing from horrific violence, but from one person who entered the US with a passport.

Now, spokespersons from Texas Presbyterian are showing some remorseful leadership by taking responsibility for the error compounded by not monitoring a nurse who cared for Mr. Duncan.
CNN -- A hospital official apologizes for blunders in handling Ebola. Schools close for fear of possible exposure. And health officials consider putting 76 hospital workers on a no-fly list after an infected nurse flew on a plane with a fever.

The Texas hospital where an Ebola patient died and two nurses became infected is apologizing for mistakes made when first confronted with the deadly virus.

Dr. Daniel Varga said the hospital mishandled the case of Thomas Eric Duncan, the Ebola patient who was originally sent home from Texas Presbyterian Health Dallas hospital even after he had a fever and said he was from Liberia.

It's obvious, based upon Governor Perry's reticence about the error now drawing media attention, that he wants nothing to do with this terrible problem.  Maybe Governor Perry should go back to the script, when he blundered so badly in one of his "wanna be" presidential debates. Remember when Governor Perry forgot what federal agency he'd abolish when asked the question during a 2011 presidential debate?  He admitted to an "ooops" moment at the time. Well, seems to  me, the governor's "ooops" has become more than a moment long, now extended to the lack of response to the overwhelming Ebola concerns now permeating the nation.  

Where is Governor Perry? His leadership gaffs are inexcusable.

Thomas Eric Duncan was young he was a Christian he even had an American sounding name

Grief is widespread throughout the Texas Presbyterian Hospital community and in Dallas, after the caregivers tried and failed to save the life of Ebola patient Thomas Eric Duncan. 

This is very sad. Mr. Duncan's death at 42 years old is a sentinel event in the history of Texas Presbyterian Hospital and another mark in the Dallas history timeline, as though anyone needs reminding of November 22, 1963.

It's difficult to understand why Mr. Duncan didn't respond to state of the art life support interventions to help him withstand the Ebola virus and recover from the illness. Undoubtedly, his inability to rally, given the intense intervention he eventually received, is a dangerous indication of just how ravaged his body was by the Ebola virus, by the time he was diagnosed. 

Certainly, given how infectious he was at the time of his diagnosis, there's a high risk of others being infected as a result of the lapse of time between the onset of his Ebola symptoms and when he was placed in quarantine for treatment.

Mr. Duncan was the first patient with Ebola to die in the US, but he became infected in Liberia. Yet, he broke the stereotype of the African who becomes ill with Ebola. He had a very American name ie, "Duncan", and he was obviously a Christian, evidenced by the family's Baptist Church pastor, who counseled the grieving relatives after providing notification of his death.  

In my opinion, Mr. Duncan's death by Ebola as well as the other Americans who are recovering from it after being flown home, breaks the stereotype of what many Americans believe are victims of this virus. 

First of all, four other Americans who had (one still has) Ebola are Caucasians. 

Mr. Duncan was certainly a young, handsome African man who worked for FedEx, or some international mail delivery company. He didn't appear to live in a primitive village and he dressed well. So, now we have evidence of how Ebola is a toxic and highly contagious disease. Everyone, regardless of race or socio economic status, who comes in contact with its victims are at great risk for becoming ill with the virus.

I'm grieving for Mr. Duncan's family and for all of the caregivers who valiantly tried in vain to save his life. 

Although Texas Presbyterian made an error when Mr. Duncan's treatment was delayed by administrative, or some other kind of glitch, the fact is, many people worked hard to cure him from the Ebola virus, and they are grieving because of his death.  

Now, Ebola is an American disease. It's urgent that Texas and all public health personnel continue to be on high alert to prevent any spread of this virus.

In Texas, this means anyone presenting in any emergency department with a fever, regardless of the origin, should receive immediate care - regardless of what their reimbursement or immigrant status may be. Therefore, Governor Perry, it seems like the right public health initiative, to reduce the Ebola panic now rampant in Dallas, is to be sure all Texans and immigrants are provided access to urgent care, regardless of their ability to pay.

Ebola response - follow the money

Ebola patients who find their way to early treatment appear to have a better chance of survival than those whose symptoms are already acute by the time they reach medical facilities. Even more of a correlation between Ebola and survival appears to be access to money to reimburse for state of the art treatment.

Fortunately, several Ebola patients who were American caregivers in Africa were able to survive the virus because they were air transported to US hospitals where preparations were made to care for them, in anticipation of the acuity of their illnesses. Their transportation and treatment were obviously expensive. 

Air transport of one ill patient to an exclusive hospital for the purpose of treating a disease, heretofore not seen before, is expensive. Nevertheless, these three particular patients recovered from the Ebola virus because, apparently, they received state of the art curative treatment. 

Evidently, the groups who sponsored these infected medical professionals when they were in Africa also paid for their recovery from Ebola.  

Of course, the Liberian man who was diagnosed with Ebola in Texas, named Mr. Duncan, didn't have a sponsor to pay for his care, when he presented with a fever at the Texas Presbyterian Hospital in Dallas. Instead of being immediately placed in isolation, Mr. Duncan was sent home. More than likely, Mr. Duncan was sent home because he didn't have enough money to pay for isolation care. More than likely, if Mr. Duncan had been sponsored by an international relief group, rather than visiting his family, he would have received isolation care immediately. Although my "more than likely" hypotheses are speculative, they're more than likely correct.

Mr. Duncan's health has deteriorated since he was finally admitted to Texas Presbyterian, after being sent home after his first visit. Meanwhile, between the time he first asked for care and when he was eventually admitted, dozens of people were exposed to his Ebola virus, meaning it's more than likely that those individuals are at risk for becoming ill. It's very difficult for me, as a nurse, to believe that Mr. Duncan's illness hasn't already infected at least one other person who he was in contact with while exhibiting a fever and symptoms of Ebola, before he was isolated. Incubation time for the virus is up to 21 days, or three full weeks.

Hopefully, Texas Presbyterian administrators should forget about who's paying for Mr. Duncan's intensive care while he's in isolation, but worry a lot about keeping him alive, whatever the cost. Otherwise, the alternative to Mr. Duncan surviving the Ebola virus ravaging his system is the potential for an infectious disease nightmare.  

Obviously, Mr. Duncan's care is expensive and more than likely much of its cost will never be reimbursed. In the event anyone in contact with Mr. Duncan becomes an Ebola patient, it's more than likely their care won't be fully reimbursed, either.

Texas is in a difficult situation regarding Mr. Duncan being the first Ebola patient diagnosed in the US. The Lone Star State of Texas is now the lonely ground zero site for Ebola in the U.S.  This is an embarrassment for the US and particularly for Texas. Nevertheless, the reality is, more than likely, if Mr. Duncan had money to pay for his care, much of this chaos and anxiety about Ebola in the US would have been preventable because he'd have been urgently isolated the minute he was assessed for being at risk. Yet, he wasn't aggressively treated, more than likely, because he couldn't pay for it.

Ebola is an infectious disease: American health care workers are front line experts

Although the etiology of the Ebola virus and longitudinal studies about the disease are ongoing, one aspect of treatment for the disease includes isolation of victims and strict infection control procedures to prevent the spread. America's health care workers are well trained to respond to an individual who presents with an infectious disease. Indeed, infection control procedures are included in all hospital personnel orientations, even among clerical staffs. Nevertheless, America's health care systems are not totally prepared to handle an epidemic of Ebola. One of the biggest problems isn't related to the causation of the disease, at all. Rather, the problem is ethical. Who will receive the most effective treatments?  Even worse, who will receive transport to a hospital for treatment?

America's health care workers are as much at risk for contracting Ebola as those who work with victims in developing countries in Africa. Most at risk are the emergency responders, who are likely the first ones called when a person becomes incapacitated by critical illness, like Ebola. Emergency providers are likely most at risk for being exposed to an Ebola outbreak, should one occur. 

Yet, there are a very limited number of ambulances available for transporting patients to a hospital or emergency treatment facility during an infectious disease outbreak, like Ebola.  

Transporting an Ebola patient puts the ambulance out of service until it's completely bathed in a chlorine disinfecting solution - twice. There are only a few transports any emergency medical transport will be able to accommodate, given the risk of Ebola exposure to the EMS responders. An additional risk of exposure includes the people cleaning the ambulance and equipment, following the transports.  

Therefore, when US public health officials are speaking confidently on national media about how Ebola will be managed, they're speaking about the disease process. They're not addressing the systems crises that will erupt as a result of the disease spreading. 

There's justifiable confidence in America's ability to respond to an isolated Ebola outbreak. Of course, the treatment of the victims will be expensive because of the intensity of the treatment of the isolated patient and the follow up "contact tracing" of those who are exposed.

It was just a matter of time before Ebola showed up in the USA. Indeed, it seems like our US health care system may have been victims of the "someplace else" delusion, like it would never happen to them. Now, it's here.  

The "someplace else" syndrome will be debunked. Health care systems will certainly pull out those pandemic policies from the years when H1N1 "bird flu" was supposed to cause a worldwide pandemic.

Meanwhile, in my opinion, the Ebola patient who traveled from Liberia to Texas before he exhibited symptoms of the illness, simply can't be an isolated incident. Not knowing who else may present as a result of the 21 day incubation time of the virus is, frankly, more dangerous than the disease itself.  

Health care workers can isolate, and treat the Ebola patient, and clean the transport and treatment equipment. 

What we can't do is predict who might be carrying the virus and where they might be located.  Therefore, the health care community isn't prepared to respond to an Ebola outbreak of more than a few people, unless a great deal of money is made available to pay for the training for a response to the disease. 

As with all infectious diseases, the most important response is prevention.  

Hand washing is the first line of defense for all infectious  diseases and more important than ever to help prevent Ebola.

America's health care providers are experts at handling infectious diseases and practicing infection control procedures. Nevertheless, the care givers and first responders are not systems analysts. 

In my opinion, our our US health care and emergency responder "systems" are not prepared to respond to an infectious Ebola outbreak.

Ebola in Texas - while innocent refugee children from Honduras were stigmatized as "diseased"

I don't believe in the concept of "poetic justice". First of all, there's rarely a direct cause and effect with seeing justice done. Rather, justice is like watching grass grow, it takes a long time to come to fruition. Certainly, justice isn't "poetic", but more like an outcome after hearing a lot of rhetoric. 

Nevertheless, when the sad news broke about the first confirmed Ebola patient to be diagnosed in the US, happened to be in Texas....well, well well. My first thought was for thousands of immigrant refugee children from Honduras who were stigmatized by right wing anti-immigration zealots, harping about them bringing "diseases" to US soil, through Texas. 

One confirmed Ebola patient is now in Texas, but this person didn't arrive via Honduras as a child refugee.  

Perhaps poetic justice exists, after all.

Or course, whoever the Ebola victim is, we pray for a full recovery as well as the protection of anyone who was in contact with the afflicted person, before presenting at a Texas hospital with the symptoms. Health care workers at the Texas hospital where the Ebola patient is now under treatment are at risk for becoming infected with the virus. Undoubtedly, front line Texas health care workers will be subject to quarantine, until the incubation period of the virus expires.

Meanwhile, I have a hard time believing that the US is the only country where an Ebola patient has come down with the viral illness. There must be others, but the diagnosis is either being withheld or death was not attributed to the Ebola diagnosis.

CNN reports:
Atlanta (CNN) -- A patient being treated at a Dallas hospital is the first person diagnosed with Ebola in the United States, health officials announced Tuesday.

The unidentified man left Liberia on September 19 and arrived in the United States on September 20, said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

At that time, the individual did not have symptoms. "But four or five days later," he began to exhibit them, Frieden said. The individual was hospitalized and isolated Sunday at Texas Health Presbyterian Hospital.

Citing privacy concerns, health officials declined to release any details about how the patient contracted the virus, what he was doing in Liberia or how he was being treated.

"I can say he is ill. He is under intensive care," Dr. Edward Goodman of the hospital told reporters.

The patient is believed to have had a handful of contacts with people after showing symptoms of the virus, and before being isolated, Frieden said. A CDC team was en route to Texas to help investigate those contacts.

The crew that transported the patient to the hospital has been isolated, the chief of staff for Dallas Mayor Mike Rawlings told CNN.

At the same time, Frieden sought to play down the risk to public health. There are currently no other suspected cases of Ebola in Texas.

"It's a severe disease, which has a high-case fatality rate, even with the best of care, but there are core, tried and true public health interventions that stop it," Frieden said.

"The bottom line here is that I have no doubt that we will control this importation or this case of Ebola so that it does not spread widely in this country," he said.

According to the CDC, Ebola causes viral hemorrhagic fever, which can affect multiple organ systems in the body and is often accompanied by bleeding.

Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat, each of which can be easily mistaken early on for other ailments like malaria, typhoid fever and meningitis.

Ebola is spread by direct contact with someone sick with the virus. That means people on the patient's flight are not thought to be at risk, as he did not begin to show symptoms until several days after arriving in the United States, Frieden said.

"The issue is not that Ebola is highly infectious. The issue with Ebola is that the stakes are so high," he told reporters.

There is no vaccination against Ebola, at this time.

Of Ebola's five subtypes, the Zaire strain -- the first to be identified -- is considered the most deadly.

The World Health Organization said preliminary tests on the Ebola virus in Guinea in March suggested that the outbreak there was this strain, though that has not been confirmed.

The Ebola virus causes viral hemorrhagic fever, which according to the U.S. Centers for Disease Control and Prevention (CDC), refers to a group of viruses that affect multiple organ systems in the body and are often accompanied by bleeding.

The director declined to answer whether the patient in Texas is a U.S. citizen? He just said he was in Texas to visit family.

Frieden also declined to say, clearly, whether the patient is a man, although he referred to the person as "he" on multiple occasions.

A number of other Americans have been diagnosed with the disease in West Africa and then brought to the United States for treatment.

The Ebola outbreak has been centered in the West African countries of Guinea, Sierra Leone and Liberia, though there have been concerns about international air travel and other factors -- including the fact the symptoms might not appear until two to 21 days after one is infected -- may contribute to its spread.

More than 3,000 people in West Africa have died after being infected with Ebola, according to a World Health Organization reportfrom last week. The same report stated that there had been 6,553 cases of the virus overall, though the number is suspected to be much higher, given difficulties in tracking and reporting the disease.

"I have no doubt that we'll stop this in its tracks in the U.S. But I also have no doubt that as long as the outbreak continues in Africa, we need to be on our guard," said Frieden.