Friday, October 24, 2014

More Insanity from CDC

Yesterday they posted guidelines that deal with providing high level support for a patient with Ebola. Such patients who have advanced disease develop renal shutdown and their blood vessels become very leaky. That is why this disease is known as viral hemorrhagic fever. When the kidneys no longer work, we start patients on dialysis but how do you safely do it while caring for a patient with Ebola. The answer is you don't.

The only facilities that could attempt something like this are BL4 isolation wards where the staff practice such techniques while wearing spacesuits. They have dedicated machines that are separated from the other hospital patients. There are only 4 such facilities in the country and the number of such beds is around 20; that is all there is, for the entire country.

The details of what took place in Houston are not known but now I wonder if they were crazy enough to try dialysis on Duncan, as he was near-dead.  Anyway, aside from the 4 BL4 labs in the country, any other place would be insane to try doing this in their own workplace. Rest assured, there are enough crazies within the medical community to give this a go.  The doctors insane enough to go jetting to West Africa so that they can see Ebola patients are not concerned with their own lives or those who are close to them. For proof, look at the recent antics by NBC news team doctor and most recently, Spencer.

Don't expect common sense out of anyone in the city, state, or federal administration.  They could have stopped the flights or at the very least instituted mandatory quarantine for all travelers from the Ebola hot zone. They didn't.

When Ebola takes root in the U.S.,  don't expect common sense from a doctor that sees you in the emergency room, hears your story about fever and diarrhea, and doesn't immediately leave the room. When one no longer needs to travel to West Africa to be exposed to this disease, making it far enough to be seen by a doctor while complaining of a fever and upset stomach, and not sitting in an isolation ward being tended to by people in space suits, means that you are in a place where other potential Ebola carriers are not being isolated. Even if you don't have this disease, you are now much more likely to have been exposed to it in that emergency room. That means, you're in the wrong place, stupid.

What we're all witnessing is a group of morons slowly driving a bus off the cliff, and the passengers mumbling softly to each other about how terrible this all is. Some of my friends tell me, you are a doctor and you must stand up and do something. "This is crazy, you must do something" they tell me.... OK, smarty. What should I do? Protest against city hall, protest against the federal government? How? Should I put on a Hazmat suit, write the government is lying to us, and show up to work dressed this way?  Someone did that, and he was laughed at.  No, I will not waste time arguing with a crowd that should really be locked up in an insane asylum.

The only thing anyone of us can do, when this spreads, is to isolate ourselves from the crazies. You still have some time to prepare for it, but it may be a very very small amount of time. Tic-toc.

And if anyone really wants to ask me what is our plan for dealing with this emergency, I will tell you. The plan is to hope that it all blows over. That is our emergency management protocol. It doesn't matter what the facts are, the talking heads will stick to that plan. This why you keep hearing, "This is very unlikely to happen here."


1 comment:

Aesop said...

Absolutely right.