Thursday, October 30, 2014

Update on Ebola situation by Gloria Poole, RN in Missouri

Ebola is in the news very much still as it seems to me to be the 21st century version of the Black Plague. Here is some of the information available on this topic that spans 3 countries in West Africa, New York, Georgia, Texas, Maine and New Jersey. I am numbering for ease of reference. 

1) Center for Disease Control 's Morbidity and Mortality Weekly Reports: 
http://www.cdc.gov/mmwr/ebola_reports.html [ all reports] and 

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6343a3.htm?s_cid=mm6343a3_w [for week of 28 Oct 2014] with quote: "The map of the cumulative incidence of Ebola, as of October 18, indicates that the highest incidence rate (>100 cases per 100,000 population) was reported by two districts in Guinea (Guéckédou and Macenta), five districts in Liberia (Bomi, Bong, Lofa, Margibi, and Montserrado), and four districts in Sierra Leone (Bombali, Kailahun, Kenema, and Port Loko) (Figure 3).

2) The latest updates on the 2014 Ebola outbreak in West Africa, including case counts, are available at http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html. 

3) The most up-to-date clinical guidelines on the 2014 Ebola outbreak in West Africa are available at http://www.cdc.gov/vhf/ebola/hcp/index.html." 

4) Surveillance and Preparedness in NYC Report [CDC MMWR]: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a5.htm?s_cid=mm6341a5_w/ with quote: "the NYC Department of Health and Mental Hygiene (DOHMH), in close coordination with local hospitals and clinicians, nongovernmental organizations and community groups, and city, state, and federal agencies, established systems around Ebola surveillance and management of suspected cases and contacts, and built upon existing general protocols for early recognition and management of persons with a viral hemorrhagic fever. Objectives included rapidly identifying Ebola patients in health care settings, implementing infection control precautions, and transporting ill persons to hospitals via emergency medical services, including persons arriving on international flights into John F. Kennedy International Airport. Enhanced planning began immediately after a CDC alert about Ebola on July 28, 2014. Reporting criteria and infection control guidance were developed in collaboration with local hospitals and sent to hospitals and clinicians via an electronic health alert system on August 11. Information also was shared on three citywide conference calls and in oral presentations to target audiences (1). DOHMH developed Ebola-specific data collection forms and triage protocols and trained staff to handle calls.
The guidance instructed clinicians to call DOHMH immediately after identifying any patient meeting the CDC definition for a person under investigation (PUI): a person who traveled to an Ebola-affected area within 21 days of onset of symptoms and had fever >101.5º F [38.5º C] and compatible symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained bleeding ". ..."planning for isolation and management of PUIs or confirmed Ebola patients. DOHMH distributed posters for health care facilities to post in emergency departments to encourage patients to report recent travel history to an Ebola-affected country upon arrival.† DOHMH medical epidemiologists were available at all hours to respond to clinician and hospital questions about PUIs or other persons suspected of having Ebola, using guidance largely consistent with CDC's risk categories. Under the system, patients with high-risk or low-risk exposure to Ebola would be transferred to another hospital if there was concern about the ability of the reporting hospital to manage the patient; Ebola testing, if indicated and after consultation with CDC, could be performed at DOHMH with confirmatory testing at CDC. Patients should also undergo evaluation for alternate diagnoses. The protocol included consideration of laboratory studies such as complete blood count, coagulation studies, liver function tests, and malaria testing, to assist in determining the need for Ebola testing. Patients not needing hospitalization could remain isolated at home, with daily monitoring by telephone by medical epidemiologists until the patient's symptoms improved such that Ebola was no longer of concern, or until worsening or persistent symptoms prompted repeat evaluation for Ebola or an alternate diagnosis.
As of October 6, 2014, DOHMH had received inquiries from health care providers about 88 patients: 49 (56%) had not been in an affected area in the 21 days before symptom onset, and 28 (32%) met travel criteria but not clinical criteria. "

5) 27 Oct 2014: That ebola exposed nurse had an elevated temperature [ a symptom of #ebola] when she was discharged from quarantine in NJ  according to http://hosted.ap.org/dynamic/stories/U/US_EBOLA_US?SITE=MOCOD&SECTION=HOME&TEMPLATE=DEFAULT;

6) http://mashable.com/2014/10/27/cdc-ebola-monitoring/?utm_cid=mash-com-Tw-main-link

7) 29 Oct 2014: http://www.bbc.com/news/health-29573993#?utm_source=twitterfeed&utm_medium=twitter

8) Krauthammer says US consensus favors quarantine of health care people returning from Africa: http://htl.li/DuWNY

9) CDC new guidelines for ebola: http://www.fiercehealthcare.com/story/cdc-issues-new-ebola-guidance-ed-workers/2014-10-28?utm_medium=nl&utm_source=internal

From CDC and FierceHealthcare: "The guidelines call on ED workers to take the following steps when treating a patient who exhibits symptoms of the deadly virus:

Take the patient's exposure history to determine whether the patient lived or traveled in a country with widespread Ebola transmission or had contact with a patient with confirmed Ebola in the previous 21 days.

If the patient meets the exposure criteria, determine if they have signs or symptoms, including a fever greater than 100.4 degrees, headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage.

If the patient with a relevant exposure history has the signs and symptoms, the ED must isolate the patient in a private room or separate enclosed area with private bathroom or covered, bedside commode and adhere to procedures and precautions designed to prevent transmission by direct or indirect contact (e.g. dedicated equipment, hand hygiene, and restricted patient movement).

If the patient arrives by ambulance, ED workers should meet the patient in a designated area away from other patients and have a process in place for safely transporting the patient on the stretcher to the isolation area with minimal contact with non-essential healthcare workers or the public.

To minimize transmission risk, only essential healthcare workers with designated roles should provide patient care. Maintain a log of all personnel who enter the patient's room. All healthcare workers who have contact with the patient should put on appropriate PPE based on the patient's clinical status.

Healthcare workers should follow the PPE recommendations if patients require invasive or aerosol-generating procedures, such as intubation, suctioning or active resuscitation) and use equipment dedicated to the patient in a pre-designated area.

At minimum, healthcare workers should wear a face shield, surgical face mask, impermeable gown and two pairs of gloves. Do not use the same equipment used to care for these patients on others until appropriate evaluation and decontamination.

Notify the hospital's infection control staff and report the case to local health departments." Read entire article: http://www.fiercehealthcare.com/story/cdc-issues-new-ebola-guidance-ed-workers/2014-10-28?utm_medium=nl&utm_source=internal

10) A 21 day quarantine was also imposed on U S astronauts and they didn't whine about it. Quarantine guideline for astronauts included 21 day quarantine: http://en.wikipedia.org/wiki/Mobile_Quarantine_Facility [tweeted to me by NYCCouncilWatch and Seth Barron] 

11) 30 Oct 2014: Comprehensive report on ebola: http://www.bbc.com/news/world-africa-28754546 includes "The Basics" of http://www.bbc.com/news/health-29556006. Remember getting droplets of contaminated fluid into the eye is being exposed to ebola since the mucus membrane lining of the eye will absorb the virus into bloodstream. 

 12) NEVER, NEVER, Never eat bats! They are carriers of several diseases  including rabies and ebola that infect humans.

13) Quote: ""Upon learning the healthcare worker intends to defy the protocols, the Office of the Governor [of Maine]  has been working collaboratively with the state health officials within the Department of Health and Human Services to seek legal authority to enforce the quarantine," the governor said. " From: http://www.reuters.com/article/2014/10/29/us-health-ebola-usa-idUSKBN0II1SP20141029?feedType=RSS&feedName=topNews&utm_source=twitter

14) http://www.newsmax.com/newswidget/us-ebola-military/2014/10/29/id/603835/?Dkt_nbr=16D5D-1&nmx_source=Atlanta_Journal_Constitution_Generic&nmx_medium=widget&nmx_content=109&nmx_campaign=widgetphase2

15) To start early intervention on any suspected of exposure to ebola you can follow The Rehydration Project  formula [how to make oral rehydration solutions at home] :http://rehydrate.org/solutions/homemade.htm w/ quote: "Made at home: ORS Solution A special drink for diarrhoea:

Give the child a drink made with 6 level teaspoons of sugar and 1/2 level teaspoon of salt dissolved in 1 litre of clean water. Be very careful to mix the correct amounts. Too much sugar can make the diarrhoea worse. Too much salt can be extremely harmful to the child. Making the mixture a little too diluted (with more than 1 litre of clean water) is not harmful."

Also, note that I am purposefully not linking any of these articles because someone tried to hijack my blog today and it took three tries to get the call to come through to login, because cyber-thugs tried to intercept my telephone as they broke into my telephone line.  You will have to copy and paste links into your browser.
30 Oct  2014: Copyright notice: this blog and all content on it is created by me and owned by me  Gloria Poole residing in Missouri but born in the state of Georgia, and it is covered by U S copyright law. I, Gloria Poole, own all rights to this blog and to all content on it, all words, all photos, and all art represented by photos that I photographed. I have the actual, tangible art I created and photographed.  This blog and or its individual posts may not be transferred to anyone anywhere,nor have domains forwarded to it that do not belong to me, nor be saved to disk, nor downloaded, nor printed at remote,  nor copied, nor photo-copied [screen-captured] , nor in any way with any method be reproduced. I, Gloria Poole, own all rights to all words, art and photos I create  with any method of technique or medium on any surface anywhere any location any reason or no reason, whether or not I photograph it on any camera, phone, etc, and whether or not I publicly display it anywhere. I have never signed a blanket waiver of my copyrights to art I have created and do not have an artist's rep [agent], nor literary agent to represent me, and never did.  I drew,  painted, signed, photographed and uploaded all art on this blog and on any blog of mine.

For the record and to establish provenance of art I have already created also: the art I have created and signed and posted to this blog of mine is part of an on-going series of art I created since year 1991 beginning in Atlanta, GA that "blossomed"  in year 2005 in  Aurora, Colorado when I lived there for one year [May 2006-May 2007], and art began to really become an integral part of my efforts to save the baby humans from premeditated destruction. In 2005, I began to realize I could use the art to illustrate my talking points in some cases, and to build a secondary "career' for me as artist.  In the year 2006 when I had endured and lived to tell about it a violent crash down a flight of stairs and had trauma, fractures, concussion, because my then-husband DBP tried to kill me to 'make it look like an accident" and he tried to twist off my broken leg, I had immobility for months except on crutches and walking boot after surgery to repair fractures and implant metal. As I sat with leg propped up I began to draw daily and paint to occupy the time and my mind. I also began to post art to the web on my blogs and websites, and also photographs I had photographed. I began a series of art then that is named "ethnic series by Gloria" [me] to attempt to draw and paint an art work of every ethnic group tribe, language, culture in the world and I created eight initial oil paintings in the first batch and posted them to the web on domains of mine.  I moved from Aurora to zip code 80203 for 2 and 1/2 years and then moved to Missouri on Oct 31, 2009 with the art I had in my possession at that time. I paint some of the sketches I created  in do-overs into oils on canvas and those are very visible on the web. I put many of them on my mini exhibit of art at https://mini-exhibition.blogspot.com, and also on my Picasa albums at https://picasaweb.google.com/gloriapoole. and also https://picasaweb.google.com/gloria0817. and on my fickr and Live online albums including :
https://onedrive.live.com/redir?resid=C639F79DB1F3CD87!141&authkey=!ADvZXW1HkLqT0OQ&ithint=folder%2cjpg

& https://onedrive.live.com/redir?resid=C639F79DB1F3CD87%21145.

 I, Gloria Poole, am a white, Southern Baptist Christian, brown-haired woman, single-again, twice-divorced,natural mother of only two children who are grown daughters named Jennifer and Leigh, and also a republican, personhood promoter, prolife activist-blogger, photographer, artist in all mediums, poet, author, illustrator, cartoonist, writer, University of Georgia alumna, U S citizen born in the state of Georgia [but I lived in several places including New York, UK briefly, Nebraska, South Carolina, Colorado, Virginia, North Carolina], former TV producer,tweeter, Registered Nurse licensed in Missouri [but before that in Georgia, UK, other states], owner/writer/blogger/ illustrator/photographer for words that WORK, and  also for Tapestry of LIFE and previously for Life Media 7 publishing when I owned the domains of it and was building up a publishing company [before cyber-criminals and thugs set out to kill me and annihilate me from the web in yr 2011] , photographer, and citizen journo . Gloria Poole is my real, born with legal name and I resumed my full maiden name including my surname of Poole legally by Court order at the time of divorce from male DBP in Colorado in Oct, 2007 at Centennial, Colorado; and I also removed the Pappas name from my name forevermore at the time of final decree in Oct 2007 . I was glad to end that four year horrible marriage of multiple trauma and injuries to me caused by male DBP, [which I testified about in Court on several occasions ].  That second divorce is public record in the state of Colorado, and my first divorce is public record in the state of Georgia. I have created art regularly since 1991, and I had formal training in drawing and in mixing colors /paint and painting in oils and I post much of the art I create on blogs of mine. You can see some of that art on one of my name blogs at https://gloriapoole.blogspot.com and see the about me page of that blog for the list of art blogs I own and post art too, that are all different. .

Copyright. Gloria Poole also known as Gloria on art I create and sign and in real life since it is my real, born with first name;  and as  Gloria Poole, RN, artist and on the web as : gloriapoole; gloria-poole; gloria.poole; artist-gloriapoole; @gloriapoole; @gloria_poole; gloria0817; gpoole817; Ms. Gloria Poole; Poole.Gloria; gloriapoole-paintings; cartooning-by-gloriapoole; photo-by-gloriapoole; gloriapoole.RN; gloriapooleRN at yahoo in which the RN is standard abbreviation for Registered Nurse, and other variations of my real, born with and legal name of Gloria Poole, at my own, private apt in Missouri which is not shared with anyone, on 30 Oct 2014 at  1:18pm.