Evening Ebola Update, Wed, 10/29: EBOV Docs teach rest of us on-line/NEJM report on clin. courses   Leave a comment

10/29/14

Dear Colleagues:

l.  Becker’s Infection Control and Clinical Quality today gives websites where hospitals/clinicians may take on-line courses on EBOV patient care given by hospitals/clinicians who have successfully treated EBOV patients in the U.S.  The Univ. of Nebraska Medical Center has a course on Moodle and iTunesU.  See: http://www.beckershospitalreview.com/quality/unmc-nebraska-medicine-offer-free-online-ebola-courses.html for details on this UNMC course.  The CDC has turned to Johns Hopkins to produce an on-line course on how to use, put on, and take off Ebola PPEs.  See:  http://www.beckershospitalreview.com/quality/johns-hopkins-to-coordinate-ebola-personal-protective-equipment-workshop.html for details.  Angelica linen service has issued guidelines to its customers on how it will handle transport of EBOV patient linens.  Basically, the patients street clothes and hospital linens will be treated as Category A Infectious Substances.  Category A means everything must be sterilized and/or autoclaved before transport will be considered.  See: http://www.beckershospitalreview.com/quality/3-guidelines-for-handling-hospital-linens-used-by-ebola-patients.html for details.  Finally, medicine is fully in the game; we now have doctors teaching doctors and nurses and techs and service workers.

2.  Dr. Flanigan’s blog reports that Dr. Tim is finishing up his two months in Liberia and will eventually return to Brown University.  But first he flies to Rome to bring Caritas up-to-date on his experience and what Catholic hospitals and HCW could do better in Liberia.  He plans to self-isolate and monitor himself in a location in or out of Rome before returning to the U.S.

3.  WHO reports on its website today that EBOV survivors have post-EBOV symptoms/signs in 50% of cases.  These sx and signs include: muscle aches, HA, fatigue, and visual symptoms.  The visual symptoms are most worrisome because we do not know if there is corneal injury or optic nerve injury or other injury.

4.  NY Times reports that Dr. Bruce Aylward of WHO says that EBOV may be slowing in Liberia because fewer cases are coming to treatment centers and more beds are unoccupied.  But Liberia may be seeing these changes because more EBOV patients are avoiding treatment centers and hospitals due to fear or stigma attached to their families.  We need to stay the course.

5.  NEJM published on-line today an article by Schleffen, et. al. entitled: ‘Clinical Illness and Outcomes in Patients With Ebola in Sierra Leone’.  This report is a summary of the clinical course of 106 patients treated at Kenema Hospital in Sierra Leone during 18 days in late May/June of 2014.  Several of the authors are also authors of Gire, et. al. article in Science last August which showed the sequence of EBOV in Sierra Leone for the same patients during the same time period.  Frequent sx and signs include: fever, HA, weakness, dizziness, and diarrhea.  These sx and signs occur in >50% of cases.  Patients >45 y,o. die at twice the rate of patients <21 y.o.  Initiation of treatment after 6 days of sx and signs, chest pain, CNS sx and signs, diarrhea, older patients are all poor prognostic signs.  See: http://www.nejm.org/doi/full/10.1056/NEJMoa1411680?query=featured_ebola for the complete NEJM report.

6.  NPR reports that initiation of treatment during the first 6 days of EBOV symptoms is key in saving EBOV patients.  Otherwise the viremia overwhelms the body and massive fluid losses and electrolyte imbalances cannot be corrected.  West Africa needs IV fluids, labs for electrolyte management on site, anti-nausea and anti-diarrheal medicines.  See: http://www.npr.org/blogs/goatsandsoda/2014/10/29/358350420/why-the-ebola-evacuees-survived-and-what-we-learned-from-them for this story.

7.  Secretary of Defense Hagel has ordered a 21 day quarantine for all military personnel in West Africa before return to the U.S.  Hagel said this was a ‘safety valve’; that these troopers were not volunteers; that trooper families wanted the quarantine for their spouses, sons, daughters, etc.; that most of the troopers were young men and women and not trained in infection control,

RGL, MD

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Posted October 29, 2014 by levittrg in Ebola

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