The CDC says we will stop Ebola in its tracks. The USA is prepared, they say. We have this fabulous, modern healthcare system, they say. It can't happen here, they say.
I won't even begin to get into the nonsense about our fabulous healthcare system all that much. I mean, we don't even have a system, let alone a fabulous one. We have a whole lot of great technology and we have a whole lot of great healthcare workers, but a system, I don't think so. A system would imply something that can take care of all our citizens. Does anyone believe that describes our "system?" We have a mess of private, not for profit, governmental, insurance company, big pharmacy, conglomeration. That's what we've got. You know that. I know that. We all know that.
Don't get me wrong, again our healthcare workers and our technology and knowledge could be a fabulous healthcare system. Capital just won't allow it to be.
Okay, enough of that.
Are we prepared for a real epidemic of something like Ebola or H5N1 flu?
A whole lot of nurses are saying they don't think so. Just last week a thousand nurses at a convention in Las Vegas staged protest rally and a die in to highlight what they said was, the lack of training, equipment and isolation rooms where suspected Ebola-infected patients in the US could be quarantined. The nurses wore hazmat suits and red shirts during the protest and also observed a moment of silence for international health workers who have died while trying to care for Ebola patients in West Africa.
The nurses were responding in part to the comments of a top federal health official who told a Senate committee last week that Ebola could come to the USA...which it now has.
- More than 60 percent of RNs say their hospital is not prepared for the Ebola virus.
- 80 percent say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola
- 85 percent say their hospital has not provided education on Ebola
- 30 percent say their hospital has insufficient supplies of eye protection (face shields or side shields with goggles) and fluid resistant gowns
- 65 percent say their hospital fails to reduce the number of patients they must care for to accommodate caring for an “isolation” patient
Here is something you have heard nothing about. What happens to infectious waste generated in the USA by an Ebola patient. Well, Reuters reports that:
Waste management companies are refusing to haul away the soiled sheets and virus-spattered protective gear associated with treating the disease, citing federal guidelines that require Ebola-related waste to be handled in special packaging by people with hazardous materials training...
Claims Journal goes further,
Many U.S. hospitals are unaware of the regulatory snafu, which experts say could threaten their ability to treat any person who develops Ebola in the U.S. after coming from an infected region. It can take as long as 21 days to develop Ebola symptoms after exposure.
The issue created problems for Emory University Hospital in Atlanta, the first institution to care for Ebola patients here. As Emory was treating two U.S. missionaries who were evacuated from West Africa in August, their waste hauler, Stericycle, initially refused to handle it. Stericycle declined comment.
Ebola symptoms can include copious amounts of vomiting and diarrhea, and nurses and doctors at Emory donned full hazmat suits to protect themselves. Bags of waste quickly began to pile up.
“At its peak, we were up to 40 bags a day of medical waste, which took a huge tax on our waste management system,” Emory’s Dr. Aneesh Mehta told colleagues at a medical meeting earlier this month.
Emory sent staff to Home Depot to buy as many 32-gallon rubber waste containers with lids that they could get their hands on. Emory kept the waste in a special containment area for six days until its Atlanta neighbor, the U.S. Centers for Disease Control and Prevention, helped broker an agreement with Stericycle.
The CDC has issued detailed guidelines on how hospitals can care for such patients, but their recommendations for handling Ebola waste differs from the U.S. Department of Transportation, which regulates the transportation of infectious waste.
CDC advises hospitals to place Ebola-infected items in leak-proof containers and discard them as they would other biohazards that fall into the category of “regulated medical waste.”
According to DOT guidelines, items in this category can’t be in a form that can cause human harm. The DOT classifies Ebola as a Category A agent, or one that is potentially life-threatening.
DOT regulations say transporting Category A items requires special packaging and hazmat training.
CDC spokesman Tom Skinner said the agency isn’t aware of any packaging that is approved for handling Ebola waste.
As a result, conventional waste management contractors believe they can’t legally haul Ebola waste, said Thomas Metzger, communication director for the National Waste & Recycling Association trade group.
Part of Emory’s solution was to bring in one of the university’s large-capacity sterilizers called an autoclave, which uses pressurized steam to neutralize infectious agents, before handing the waste off to its disposal contractor for incineration.
Few hospitals have the ability to autoclave medical waste from Ebola patients on site.
“For this reason, it would be very difficult for a hospital to agree to care for Ebola cases – this desperately needs a fix,” said Dr Jeffrey Duchin, chair of the Infectious Diseases Society of America’s Public Health Committee.
Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, said there’s “no way in the world” that U.S. hospitals are ready to treat patients with highly infectious diseases like Ebola.
“Where they come undone every time is the management of their liquid and solid waste,” said Macgregor-Skinner, who recently trained healthcare workers in Nigeria on behalf of the Elizabeth R. Griffin Research Foundation.
Skinner said the CDC is working with DOT to resolve the issue. He said the CDC views its disposal guidelines as appropriate, and that they have been proven to prevent infection in the handling of waste from HIV, hepatitis, and tuberculosis patients.
At the Las Vegas rally RoseAnn DeMoro, executive director of National Nurses United said that the time for a dramatic response to this stuff is now.Joe Delcambre, a spokesman for DOT’s Pipeline and Hazardous Materials Safety Administration, could not say whether requiring hospitals to first sterilize Ebola waste would resolve the issue for waste haulers. He did confirm that DOT is meeting with CDC.
“The clock is ticking. It is long past time to act,” Castillo said. Preparedness for disease outbreaks is a long standing problem, note the nurses, citing the death of a U.S. nurse in a California hospital infected during the H1N1 outbreak in 2009.
NNU is calling for:
- All U.S. hospitals to immediately implement a full emergency preparedness plan for Ebola, or other disease outbreaks. That includes full training of hospital personnel along with proper protocols and training materials for responding to outbreaks, adequate supplies of all personal protective equipment, properly equipped isolation rooms to assure patient, visitor and staff safety, and sufficient staffing to supplement nurses and other health workers who need to care for patients in isolation.
- Significant increases in provision of aid, financial, personnel, and protective equipment, from the U.S., other governments, and private corporate interests to the nations in West Africa directly affected to contain and stop the spread of Ebola.
- Proper funding of international disaster relief and global health agencies whose budgets have been cut as a result of austerity measures implemented by the wealthiest nations.
- Stepped up action on the climate crisis which has contributed to the spread of disease outbreaks. Scientific American in 2008 named Ebola, which is directly affected by drought-related deforestation, as one of a dozen epidemics likely to be spurred by climate change.
The World Health (WHO) says the upward epidemic trend continues in Sierra Leone and most probably also in Liberia. By contrast, the situation in Guinea appears to be more stable, though it must be emphasized that in the context of an outbreak of EVD, a stable of transmission is still of grave concern, and could change quickly.This is a leap from 6553 (probable, confirmed and suspected) cases and 3083 deaths reported as of Sept. 23.
No, it is not and, as I have written previously in several earlier posts here, while the virus is the direct cause of these deaths it is global capital, healthcare inequality, poverty, and racism which is the true culprit in this and related epidemics.
NOTE: There is one other thing I have to say which troubles me. Everyone is relying a whole lot on self reporting and self quarantining, and the like. I think experience (including my own history of work in community health) says, "that's a nice thought," but certainly cannot always be counted upon.
The following is a press release from National Nurses United.
Nurses Call on U.S. Hospitals to Improve Emergency Preparedness for Potential Ebola U.S. Infections
- Full training of hospital personnel along with proper protocols and training materials for responding to outbreaks,
- Adequate supplies of Hazmat suits and other personal protective equipment
- Properly equipped isolation rooms to assure patient, visitor and staff safety,
- Sufficient staffing to supplement nurses and other health workers who need to care for patients in isolation.