ER Doctor: Today's Ebola is tomorrow's Spanish flu

Long but interesting read Source

Something I hadn't seen before:

The Spanish-flu mortality rate of 1918 was 2 to 5 percent.

a reply to: JG1993

ah, you beat me to the posting. I found this to be a very interesting read. Especially this part;

Some years ago when I first started in practice, a very large hospital in our area was having trouble getting patients rapidly admitted from the ER to the floors. This resulted in a tremendous backlog of patients and extreme ER overcrowding. This naturally increased patient wait times and directly impacted the health of those coming to the ER. So, naturally, the hospital system formed a committee and hired consultants. They looked at every single variable: time to laboratory, time to X-ray, nursing changeover, bed request time and on and on and on. Do you know what they found? The roadblock in the movement of patients through this major medical system was housekeeping. Think about that. Housekeepers, traditionally the lowest paid and least-skilled division of employment of the hospital, were responsible for the movement and throughput of patients more than any other factor.

If the rooms on the floor were not cleaned fast enough, then no patients could move from the ER to the floor, and no patients from the waiting room to the ER. ER wait times rose and patient care suffered. Housekeepers handcuffed the entire system, and not because they were lazy. The regulations, protocols and procedures put into place to clean a room are so extensive that rapid room turnover was next to impossible with the current staffing model. That stuck with me. What is the rate-limiting step in a mass casualty scenario or massive patient influx that would handcuff us? Where will all the preparedness collapse? What is the leaking O-ring? What am I afraid will fail?

Put that in your pipe and 'moke it.

Now imagine that huge numbers of hospital staff – from doctors to housekeepers, from food services to registration, from security and parking to transportation will decide not show up. They will call in sick or simply just say: “No, I’m not coming to work today.” In just a few days, human waste, debris, soiled linens, the sick, the dying and the bodies will pile up. We will be overwhelmed and unable to offer much in the way of assistance because the labor-intensive protocols that allow us to safely care for even one patient are just too exhausting. These procedures are barely repeatable more than once or twice of day, and fraught with so many steps and potential for mistake that it becomes too physically and emotionally taxing for the staff to do … so they simply wont show up.

And I am not sure I will, either

The influx of patients in any major outbreak will quickly overwhelm the health care system. it is the result of things getting out of hand, which is a result of things getting started and down played, which is the direct result of the greedy friggin' airlines that insist people be allowed to fly around the world possibly spreading the virus to places it isn't yet.

The evidence of that is the bullet dodging going on. Spain, Dallas, New York… any others since the weekend? If it gets down to the heath care system becoming so overwhelmed in the US that workers begin to go AWOL, then we are in for the same sort of amplification numbers going on in Africa right now.

The problem isn't whether we can handle a few cases, the problem is if the few cases keep coming.

Ive been sayin the PTB haven't a clue how the epidemic would play out...people wont do what they expect at all......
well be overwhelmed if it takes off at all..........nobody gets it....

a reply to: intrptr

Here in beaumont Texas I'd say 90% of the nurses I know are married to men in the oilfield that make good money.
Their families would be just fine on the husbands income alone, and if going to work at the hospital could possibly put the family in danger I'm sure the decision to stay home would be a no brainer for most of them.
Another factor that would probably keep a lot of mothers home from their usual hospital duties would be school closings. If schools start closing for fear of ebola, you can bet that many mothers in the healthcare field will think twice about going into work, especially if she has any other means of income.

I can personally attest to the info about the bed-turnover issue being a factor of how long it takes to clean a hospital room; for a while back in the 70s I worked as a 'patient placement registrar' if I remember the title correctly. I was in charge of finding beds for everyone that came in through the ER overnight, Fridays, Saturdays and Sundays. What a nightmare. Where to put a stroke patient when the neurology unit was full? Where to put a GSW victim when post-surgical was on overflow and we were shortstaffed because it was flu season? Every damn time, the response was the same to 'where's my bed'? Housekeeping hadn't gotten around to it yet. At first I thought administration was too cheap to hire enough housekeepers but the real problem was finding people at any wage to work those hours, doing that kind of work, which was actually quite meticulous and detailed, not to mention heavy labor. It required youth and stamina and young people don't want to work those hours, doing that kind of stuff. Turns out they had trouble staffing the 'patient placement registrar' openings too; I quickly tired of being yelled at by the guys down in the ER because I couldn't poof beds up out of thin air. You get jaded fast when your reaction to a phone call 'someone died in the ICU' is 'YESSSS!!!' because now you've got a bed that will be available in a few hours...

That death rate from the Spanish Flu doesn't seem right at all. I'm wary of the stats; that was war time, people would have been sick with the Spanish Flu, the regular flu and various and sundry colds, too. I don't think they had any way of testing for what flu people had, either. Hard to believe good statistics were being kept, especially since the death rate 'from the Spanish Flu' but mostly during that two year period was anywhere between a reported 10-20 million globally, to 50-100 million globally. Lots of variance in those statistics. The Spanish Flu was feared because it killed the young adults fast and furiously - their strong immune systems did them in with a cytokine storm; people were healthy at breakfast, sick at lunch and drowned in their own secretions by dinner. Physicians of the time described the final hours; people turned the color of blueberries, their oxygenation was so poor.

a reply to: JG1993

The problem seems to be ultimately a logistical and communication problem. Trying to keep masses of sick contagious people from instinctively running to the nearest hospital, so that they can be "patients", be treated and survive. How can a group like this be diverted and ultimately convinced to stay home ? We need somebody we trust and will listen to.....our fearless leaders in D.C. ?? A real movement of common sense ideas , precautions and simple preventative measures that convinces people to be responsible for themselves. What are the chances of that ever happening ?

And here we have it: What will it take to overwhelm the system?

This is why we should be quarantining and doing everything else at our disposal to make sure this thing remains a trickle issue at worst, but for some reason, our "betters" seem to think we can handle it with no restrictions.

We can make a few mistakes with Ebola, but if this were an airborne bug like the flu? We'd already be screwed.

I am not encouraged by anything I'm seeing in this.

originally posted by: conspiracytheoristIAM



a reply to: JG1993

The problem seems to be ultimately a logistical and communication problem. Trying to keep masses of sick contagious people from instinctively running to the nearest hospital, so that they can be "patients", be treated and survive. How can a group like this be diverted and ultimately convinced to stay home ? We need somebody we trust and will listen to.....our fearless leaders in D.C. ?? A real movement of common sense ideas , precautions and simple preventative measures that convinces people to be responsible for themselves. What are the chances of that ever happening ?

With a 60% death rate (on the low end of the estimate), I hope you are kidding. Early treatment seems key to survival if you do have it. You are not going to convince people to just be responsible for themselves, it's asking them to roll the dice on their lives when the odds are stacked against them. In the end doing such could actually contribute to the spread of disease.

So basically he's saying there will be cowards, and that he will most likely be a coward himself. pretty much the only thing I got from this article.

a reply to: redhorse

Apparently you didn't read the article the OP presented. In it the doctor explains why people should stay away from a hospital.........so it wouldn't be overwhelmed ! If the death rate is 50% , how many hospital workers will actually keep going to work ? Once again you need to read the article before commenting on what I said. He explained why people sick with ebola should stay home.....rest , fluids and prayer were his suggestion for care, which can be accomplished just as well at home. Ebola has no cure and most people in W. Africa have died from it !! Conditions are better here , because there is no endemic as of yet. If ebola spreads here like it has in Africa, things will become just as chaotic. We need to quarantine all returning from W. Africa , now !! And no I wasn't kidding...read the damn article.

a reply to: clenz


I think you're confusing cowardice with the reality of the situation. If this disease , ebola, gets out of hand our health-care system will rapidly collapse. The ER doctor in the OP's article explains it quite well !

Infected doctors and nurses were one of the primary means of contagion during the first months of the outbreak in Africa. It does make sense that they are slightly terrified and the argument he makes is actually a pretty solid one in my opinion.

Cheers!

originally posted by: conspiracytheoristIAM
a reply to: clenz


I think you're confusing cowardice with the reality of the situation. If this disease , ebola, gets out of hand our health-care system will rapidly collapse. The ER doctor in the OP's article explains it quite well !

I guess we can just toss the Hippocratic Oath out the window if things get too "scary" eh?

This article is just another of many that is filled with the words "if" too many times.

a reply to: JessicaRabbitTx

That was avery insightful reply from someone who knows what time it is. Thanks for the clarity.

regards,

intrptr

originally posted by: conspiracytheoristIAM
a reply to: redhorse

Apparently you didn't read the article the OP presented. In it the doctor explains why people should stay away from a hospital.........so it wouldn't be overwhelmed ! If the death rate is 50% , how many hospital workers will actually keep going to work ? Once again you need to read the article before commenting on what I said. He explained why people sick with ebola should stay home.....rest , fluids and prayer were his suggestion for care, which can be accomplished just as well at home. Ebola has no cure and most people in W. Africa have died from it !! Conditions are better here , because there is no endemic as of yet. If ebola spreads here like it has in Africa, things will become just as chaotic. We need to quarantine all returning from W. Africa , now !! And no I wasn't kidding...read the damn article.

Relax there cupcake. If you think I didn't read the article it's fair enough to call me out, and you're right I didn't. You don't need to go from 0 to Cussing Hissy Fit though. Good grief.

I don't remember locking horns with you before so I'm not sure what you mean by "once again", maybe you've got me confused with someone else..? Or you're just fed up with people Not Reading The Articles(!), (seems like there's better things to get your panties in a bunch about but that's me).

Either way... Statement still stands. I don't agree with this Doctor. He's right about one thing though, he does seem to have no sympathy for the very ill, which makes me think perhaps he is in the wrong profession. People shouldn't stay home if they think they are infected. This guy is dead wrong, or at least, get OTHER people killed wrong.

a reply to: redhorse



redhorse, I'll skip past the panties bunched and cup cake crap..... You're the one who called me out about my opinion, before even reading what I commented on. You seem to be confused about ebola.....there is no "treatment " early or late, except some hope for a vaccine. All that can be done is to keep people hydrated and as comfortable as possible. If their immune system is strong enough, they'll live. Remember the adage the ER doctor used, "a hospital is no place for a sick person ". What that implies to me is that a hospital with too many contagious people is dangerous for all the patients there. It's not that the ER doctor has no sympathy, it's that he is a realist ,because a regular hospital is not set up for a level 4 contagion such as ebola. Why do you think they moved Pham and Vinson out of Dallas ? They were transported to a hospital designed to handle ebola. There are only a few such hospitals here in the U.S. and that's why , I think, the ER doctor wrote the piece....trying to warn what may be coming !!