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Post by djAdvocate on Oct 15, 2014 17:42:48 GMT -5
Facemask?...I don't think that word means what you think it does. edit: i believe i said face SHIELD. if i am mistaken, let me know. check it out. in the CDC illustration it covers the entire neck. my guess is that it is designed to protect against stuff that flies off the patient toward the nurse. the same terminology is used in welding. a face shield actually protects the face AND the neck against slag and flash. so, it might actually be you that doesn't understand the term, or you are taking it far to literally. perhaps that is Megyn's problem, as well.
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mmhmm
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Post by mmhmm on Oct 15, 2014 17:49:25 GMT -5
The story of how much contact the infected nurses had with the index patient and when keeps changing. According to this NYT story, both Ms. Phram and Ms. Vinson had extensive contact with him during the critical first three days when the PPE was horrifically inadequate, bizarrely used, and protocols for removing it were apparently nonexistent. Dr. Frieden confirmed some of the nurses’ claims and complaints. He said the critical period was the first three days of Mr. Duncan’s care before he was confirmed to have Ebola and before the C.D.C. team arrived in Dallas — Sept. 28, 29 and 30. Both Ms. Pham and Ms. Vinson had extensive contact with Mr. Duncan during those three days, and although officials have not yet determined how the two nurses became infected, they were focusing on their use of protective clothing and gear.
This is not good news. I was really hoping that exposure could be traced to a later date. I wasn't alone in that hope either. A lot of the news media seemed to be leaning in the same direction. Expect more cases. i think this might be a good chance for mmhmm to chime in on how much "intimate contact" a typical nurse would have with a typical flu patient: 1) nil 2) some 3) a lot also- how MANY NURSES treat the average flu patient? 1-2? more than 2? more than 10? thx If treating a very sick flu patient in the hospital, the nurse will have quite a bit of close contact with that patient, as will nurse's aides and other auxiliary personnel. If the patient is hospitalized for a few days, you'll have more than 10 in close contact. That said, we don't get many flu patients who require hospitalization. This enterovirus D68 is a little different, though. We've had quite a few hospitalizations with that one. I don't understand why anyone would be looking for a later date of transmission, though. This guy was shedding virus when he entered the hospital the second time. It was several days before they realized it was Ebola. Since the Ebola virus interferes with the production of interferon (part of the body's defense mechanism), the longer the patient is sick the more the virus replicates and the more of it is shed. While it's easier to get the further along the disease process is, he was already pretty darned sick when he got to the hospital.
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Post by haapai on Oct 15, 2014 17:52:21 GMT -5
Of course it is possible that the Times was placing entirely too much confidence in Drs. Frieden and Varga, both of whom have lost tremendous amounts of credibility in the last 24 hours.
It's not clear at all when the Times wrote this story. Parts of it sure sound like a rehash of what they published this morning.
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Post by djAdvocate on Oct 15, 2014 18:06:52 GMT -5
i think this might be a good chance for mmhmm to chime in on how much "intimate contact" a typical nurse would have with a typical flu patient: 1) nil 2) some 3) a lot also- how MANY NURSES treat the average flu patient? 1-2? more than 2? more than 10? thx If treating a very sick flu patient in the hospital, the nurse will have quite a bit of close contact with that patient, as will nurse's aides and other auxiliary personnel. If the patient is hospitalized for a few days, you'll have more than 10 in close contact. That said, we don't get many flu patients who require hospitalization. This enterovirus D68 is a little different, though. We've had quite a few hospitalizations with that one. I don't understand why anyone would be looking for a later date of transmission, though. This guy was shedding virus when he entered the hospital the second time. It was several days before they realized it was Ebola. Since the Ebola virus interferes with the production of interferon (part of the body's defense mechanism), the longer the patient is sick the more the virus replicates and the more of it is shed. While it's easier to get the further along the disease process is, he was already pretty darned sick when he got to the hospital. thanks, mmhmm. not very comforting, but quite informative.
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Post by djAdvocate on Oct 15, 2014 18:08:23 GMT -5
Of course it is possible that the Times was placing entirely too much confidence in Drs. Frieden and Varga, both of whom have lost tremendous amounts of credibility in the last 24 hours. It's not clear at all when the Times wrote this story. Parts of it sure sound like a rehash of what they published this morning. sorry, but i am not following the names of the players. who are those doctors?
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Post by haapai on Oct 15, 2014 18:14:12 GMT -5
A later exposure date indicates that more folks that are closer to being in the clear. It also has encouraging implications for the relative infectiousness of the disease in its early stages.
I'm far from the only person that had this hope. A whole lot of people were clinging to the hope that the disease was wildly infectious in the later stages but relatively hard to get in the earlier stages.
I hope the Times has these details wrong.
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Post by mmhmm on Oct 15, 2014 18:15:48 GMT -5
If treating a very sick flu patient in the hospital, the nurse will have quite a bit of close contact with that patient, as will nurse's aides and other auxiliary personnel. If the patient is hospitalized for a few days, you'll have more than 10 in close contact. That said, we don't get many flu patients who require hospitalization. This enterovirus D68 is a little different, though. We've had quite a few hospitalizations with that one. I don't understand why anyone would be looking for a later date of transmission, though. This guy was shedding virus when he entered the hospital the second time. It was several days before they realized it was Ebola. Since the Ebola virus interferes with the production of interferon (part of the body's defense mechanism), the longer the patient is sick the more the virus replicates and the more of it is shed. While it's easier to get the further along the disease process is, he was already pretty darned sick when he got to the hospital. thanks, mmhmm. not very comforting, but quite informative. People tend to forget all the ancillary personnel who work with the patients. Now, in a case like Ebola, that patient will be in isolation, so the number of contacts will be significantly reduced. Most nurses work 12-hour shifts, so you'd have one nurse on days and one on nights. These nurses work 3 shifts a week, so that's 6 nurses a week for that patient. Depending on how sick the patient is, you might double that for a very sick patient needing 2-on-one care. No nurse's aides would be used in that area; however, housekeeping would be, so that's at least one other person a day. I'm not sure how they're staffing these new high-level isolation areas (like Emory, or the one in Nebraska). They may take a team approach. I just don't know.
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Post by b2r on Oct 15, 2014 18:16:35 GMT -5
Facemask?...I don't think that word means what you think it does. edit: i believe i said face SHIELD. if i am mistaken, let me know. check it out. in the CDC illustration it covers the entire neck. my guess is that it is designed to protect against stuff that flies off the patient toward the nurse. the same terminology is used in welding. a face shield actually protects the face AND the neck against slag and flash. so, it might actually be you that doesn't understand the term, or you are taking it far to literally. perhaps that is Megyn's problem, as well. Not to , but you will note(I hope) the workers in the CDC PPE instructional are not wearing so much as a welder's hat on the sheilded face. And slag? That would never think of sneaking around the edge of your sheild to get at your neck. Your prolly write tho tis me thatz not unnerstannin!
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Post by mmhmm on Oct 15, 2014 18:18:00 GMT -5
A later exposure date indicates that more folks that are closer to being in the clear. It also has encouraging implications for the relative infectiousness of the disease in its early stages. I'm far from the only person that had this hope. A whole lot of people were clinging to the hope that the disease was wildly infectious in the later stages but relatively hard to get in the earlier stages. I hope the Times has these details wrong. Mr. Hudson wasn't in that early a stage, though. He was already vomiting, and had diarrhoea when he was brought to the hospital the second time. Then, it took several days before they diagnosed Ebola. He was already pretty well along by the time they diagnosed.
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Post by haapai on Oct 15, 2014 18:21:32 GMT -5
Dr. Frieden is the director of the CDC. Dr. Varga works for Texas Health Resources.
They are both spin doctors.
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Post by djAdvocate on Oct 15, 2014 18:21:35 GMT -5
edit: i believe i said face SHIELD. if i am mistaken, let me know. check it out. in the CDC illustration it covers the entire neck. my guess is that it is designed to protect against stuff that flies off the patient toward the nurse. the same terminology is used in welding. a face shield actually protects the face AND the neck against slag and flash. so, it might actually be you that doesn't understand the term, or you are taking it far to literally. perhaps that is Megyn's problem, as well. Not to , but you will note(I hope) the workers in the CDC PPE instructional are not wearing so much as a welder's hat on the sheilded face. actually, the face shield shown is almost identical to a grinding shield used when grinding slag (i took a minute to go grab one, bring it in here, and compare it). it is a clear shield, worn on the head, and it protects the face and neck. like i say, if you put the one shown in the CDC illustration against the one my guys are wearing, you could not tell the difference.And slag? That would never think of sneaking around the edge of your sheild to get at your neck. Your prolly write tho tis me thatz not unnerstannin! i can't remember the last time one of my guys got burned by slag. however, i remember the last time i did. i wasn't wearing a face shield. it went OVER MY GLASSES and STUCK TO MY EYELID. quite memorable, i assure you. but perhaps not as memorable to OTHERS as DYING would be.
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Post by djAdvocate on Oct 15, 2014 18:23:08 GMT -5
Dr. Frieden is the director of the CDC. Dr. Varga works for Texas Health Resources. They are both spin doctors. oh yeah. i remember those a-holes from the first interview they did, where they took SIX QUESTIONS and walked off during a press briefing. edit:: i was referring to Varga above. i think a lot more of Freiden than anyone involved with this problem in Texas directly.
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Post by Rocky Mtn Saver on Oct 15, 2014 18:23:10 GMT -5
A later exposure date indicates that more folks that are closer to being in the clear. It also has encouraging implications for the relative infectiousness of the disease in its early stages. I'm far from the only person that had this hope. A whole lot of people were clinging to the hope that the disease was wildly infectious in the later stages but relatively hard to get in the earlier stages. I hope the Times has these details wrong. I'm not sure I agree with those ideas. Maybe I'm confused, but I see the date she was exposed as not an issue like you do. First, if the nurses were not wearing full protection in those first few days, it would explain better how they were exposed and where the hole in the system was. It's best to know where the hole was so it can be plugged. Since Mr. Duncan was already very sick and expelling bodily fluids when he arrived, he was known to be contagious the moment he came in. That they were exposed because of an obvious lack of protection is, to me, better than thinking that a huge viral load was getting through all the later protections. Second, the 21-day clock to expose others starts for each person upon symptoms or a positive test. So, it doesn't matter if the nurse was exposed 1 day ago or 20 days ago, her clock (as I understand it) for exposing others begins the moment she shows symptoms. When she herself was exposed doesn't alter her 21-day clock as a risk. Or do I misunderstand the clock? Third, if the two nurses were exposed longer ago, that actually seems to me that this is actually good news for others exposed to Mr. Duncan, because the most likely time for symptoms to appear (8-10 days) has effectively already passed.
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Post by mmhmm on Oct 15, 2014 18:38:18 GMT -5
The 21-day clock measures the time from exposure to clear of danger. It's measuring how many days from exposure it's possible to become ill. Mr. Duncan's family will be clear on Saturday. Friday will be the 21st day since they were exposed. I'm sure they'll be ecstatic to escape from prison and I sure hope it happens for all of them.
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Post by Miss Tequila on Oct 15, 2014 18:39:03 GMT -5
according to Megyn, their necks were exposed, which means they were NOT wearing any of the bolded items, even though the CDC recommends them. and yet you and her see fit to blame the CDC? repeat after me "government bad, private company good" goggles OR faceshield.....
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Post by Rocky Mtn Saver on Oct 15, 2014 18:51:27 GMT -5
The 21-day clock measures the time from exposure to clear of danger. It's measuring how many days from exposure it's possible to become ill. Mr. Duncan's family will be clear on Saturday. Friday will be the 21st day since they were exposed. I'm sure they'll be ecstatic to escape from prison and I sure hope it happens for all of them. Yeah, perhaps I'm not explaining myself well. I'm not understanding how her own time of exposure (not symptoms) affects anyone else's risk, as haapai indicated. The nurse's time of exposure being shorter or longer doesn't affect the 21 day clocks of anyone else, I guess I mean, because the clock begins when she could be potentially contagious (symptoms appearring on 10/14), regardless of her own time of exposure (whether 10/01 or 10/11). I guess she does have a longer time to be potentially a risk to health care workers while in isolation with the CDC...
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Post by mmhmm on Oct 15, 2014 18:55:41 GMT -5
The 21-day clock measures the time from exposure to clear of danger. It's measuring how many days from exposure it's possible to become ill. Mr. Duncan's family will be clear on Saturday. Friday will be the 21st day since they were exposed. I'm sure they'll be ecstatic to escape from prison and I sure hope it happens for all of them. Yeah, perhaps I'm not explaining myself well. I'm not understanding how her own time of exposure (not symptoms) affects anyone else's risk, as haapai indicated. The nurse's time of exposure being shorter or longer doesn't affect the 21 day clocks of anyone else, I guess I mean, because the clock begins when she could be potentially contagious (symptoms appearring on 10/14), regardless of her own time of exposure (whether 10/01 or 10/11). I guess she does have a longer time to be potentially a risk to health care workers while in isolation with the CDC... I see what you were getting at now. The nurse's time of exposure, at this point, is irrelevant. She has Ebola and is currently in isolation. As long as protocols are followed religiously (ahem!) she's not going to infect anybody.
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Post by Deleted on Oct 15, 2014 18:59:54 GMT -5
The 21-day clock measures the time from exposure to clear of danger. It's measuring how many days from exposure it's possible to become ill. Mr. Duncan's family will be clear on Saturday. Friday will be the 21st day since they were exposed. I'm sure they'll be ecstatic to escape from prison and I sure hope it happens for all of them. Yeah, perhaps I'm not explaining myself well. I'm not understanding how her own time of exposure (not symptoms) affects anyone else's risk, as haapai indicated. The nurse's time of exposure being shorter or longer doesn't affect the 21 day clocks of anyone else, I guess I mean, because the clock begins when she could be potentially contagious (symptoms appearring on 10/14), regardless of her own time of exposure (whether 10/01 or 10/11). I guess she does have a longer time to be potentially a risk to health care workers while in isolation with the CDC... I think hapaii was hoping that the nurse caught Ebola from Mr. Duncan later in his illness, meaning (possibly) that people that were near him earlier were not as likely to get the disease. I think the post was about how contagious Mr. Duncan was as his illness progressed, more than about the nurse exposing others. Did I clear that up or make it worse? Lol
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Post by haapai on Oct 15, 2014 19:07:35 GMT -5
I believe that the longest recorded lag between last possible exposure to Ebola and the onset of symptoms is 22 days.
The folks who Mr. Duncan was staying with last had contact with him on the 28th. However, they were subsequently confined to the contaminated apartment for four days. I think it would be reasonable to start the clock on the day that they left the apartment.
I'm really tired and not able to explain why I was hoping that Ms. Phram and Ms. Vinson were not involved in Mr. Duncan's early care. It certainly seems counter-intuitive to be hoping that infection occurred while the nurses were adequately garbed but breeched protocol in removing the garb but that's exactly what I was hoping for. It's a terrifying possibility for anyone treating a diagnosed Ebola patient, but were it the case, it would have very positive implications for anyone who has come into contact with a symptomatic Ebola patient before adequate PPE or protocols have been deployed.
Perhaps in the morning, I'll be able to explain myself better. Or maybe the errors in my logic will come to me overnight.
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Post by mmhmm on Oct 15, 2014 19:15:16 GMT -5
I believe that the longest recorded lag between last possible exposure to Ebola and the onset of symptoms is 22 days.
The folks who Mr. Duncan was staying with last had contact with him on the 28th. However, they were subsequently confined to the contaminated apartment for four days. I think it would be reasonable to start the clock on the day that they left the apartment.
I'm really tired and not able to explain why I was hoping that Ms. Phram and Ms. Vinson were not involved in Mr. Duncan's early care. It certainly seems counter-intuitive to be hoping that infection occurred while the nurses were adequately garbed but breeched protocol in removing the garb but that's exactly what I was hoping for. It's a terrifying possibility for anyone treating a diagnosed Ebola patient, but were it the case, it would have very positive implications for anyone who has come into contact with a symptomatic Ebola patient before adequate PPE or protocols have been deployed.
Perhaps in the morning, I'll be able to explain myself better. Or maybe the errors in my logic will come to me overnight.
This virus can only live on surfaces for several hours, not several days, haapai. The day he left their home the second time is the right day to start the countdown unless there was a puddle of wet blood, or other body fluid in that house and one, or more of them got into it. The fact that none have even shown symptoms tells me that was very probably not the case. It is very difficult to transmit this virus in the early stages (think fever, no vomiting, no diarrhoea). There's just not enough of it in the bloodstream. Once the overt symptoms start, however, it's replicating and blocking interferon which will result in even faster replication. The longer it goes, the more it replicates and the more dangerous it is. That's the long and the short of it.
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Post by Rocky Mtn Saver on Oct 15, 2014 19:19:39 GMT -5
I believe that the longest recorded lag between last possible exposure to Ebola and the onset of symptoms is 22 days.
The folks who Mr. Duncan was staying with last had contact with him on the 28th. However, they were subsequently confined to the contaminated apartment for four days. I think it would be reasonable to start the clock on the day that they left the apartment.
Where did you see 22 days? Everything I've read says 2 to 21 days. I've not heard of the quarantine period for those 4 family members being changed because they were in the contaminated apartment, although that's possible. I suppose that we'll see what happens on Friday, as to whether they announce that the quarantine is lifted at that point or not.
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Post by djAdvocate on Oct 15, 2014 19:48:40 GMT -5
according to Megyn, their necks were exposed, which means they were NOT wearing any of the bolded items, even though the CDC recommends them. and yet you and her see fit to blame the CDC? repeat after me "government bad, private company good" goggles OR faceshield..... right. depending on what the situation calls for. if there are fluids splashing all over the place, or you have injuries on your neck, FACE SHIELD. if not, GOGGLES. same deal in the shop. if you are working on a belt sander, your odds of getting something in the neck are nil, pretty much. goggles are the requirement, there. the CDC is not going to micromanage your hospital for you. they are not going to tell you specifically what to wear, and when to wear it. they are going to issue RECOMMENDATIONS, and defer to BEST PRACTICES. seriously, i think that we are making way too much of the CDC's roll here. if they told the hospitals to wear $1M pressure suits with hepa filntration systems and breathing systems, i am sure those would be quite safe. but i am also sure that protecting your eyes is also quite safe under normal circumstances. my point was that if you read through the CDC SUGGESTIONS, they address every single one of the objections that FOX News raised. what ever happened to personal responsibility?
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Post by Miss Tequila on Oct 15, 2014 20:37:20 GMT -5
goggles OR faceshield..... right. depending on what the situation calls for. if there are fluids splashing all over the place, or you have injuries on your neck, FACE SHIELD. if not, GOGGLES. same deal in the shop. if you are working on a belt sander, your odds of getting something in the neck are nil, pretty much. goggles are the requirement, there. the CDC is not going to micromanage your hospital for you. they are not going to tell you specifically what to wear, and when to wear it. they are going to issue RECOMMENDATIONS, and defer to BEST PRACTICES. seriously, i think that we are making way too much of the CDC's roll here. if they told the hospitals to wear $1M pressure suits with hepa filntration systems and breathing systems, i am sure those would be quite safe. but i am also sure that protecting your eyes is also quite safe under normal circumstances. my point was that if you read through the CDC SUGGESTIONS, they address every single one of the objections that FOX News raised. what ever happened to personal responsibility? The hospitals are not prepared for Ebola. The CDC is incompetent and the director needs to be fired. Turns out the nurse called the cdc and they cleared her to fly. This is one big clusterfuck. Thank god it isn't airborne because with the shit show going on we would all be in serious trouble
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Post by haapai on Oct 15, 2014 20:39:51 GMT -5
That same patient is now being transferred to Emory, right in the CDC's back yard.
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Post by mmhmm on Oct 15, 2014 20:52:13 GMT -5
With normal variance in temperature, anything less than 100.4 is not considered to be abnormal. There are many people whose temperatures normally run at about 99 or 99.5. I imagine that's why they cleared her. Considering the circumstances, however, I would not have done so. Somebody was going "by the book" and the book needs to be questioned in situations like this, not held up as the be-all-end-all.
While I'm sure there are hospitals that aren't ready, I'm also sure there are hospitals that are ready. Thing is, all of them have to get ready!
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Post by Miss Tequila on Oct 15, 2014 20:56:16 GMT -5
With normal variance in temperature, anything less than 100.4 is not considered to be abnormal. There are many people whose temperatures normally run at about 99 or 99.5. I imagine that's why they cleared her. Considering the circumstances, however, I would not have done so. Somebody was going "by the book" and the book needs to be questioned in situations like this, not held up as the be-all-end-all. While I'm sure there are hospitals that aren't ready, I'm also sure there are hospitals that are ready. Thing is, all of them have to get ready! Why should they have cleared her? Nancy Snyderman doesn't even have a fever and she is under mandatory quarantine. But the cdc clears this woman to fly? Makes no sense to me
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Post by mmhmm on Oct 15, 2014 20:57:09 GMT -5
With normal variance in temperature, anything less than 100.4 is not considered to be abnormal. There are many people whose temperatures normally run at about 99 or 99.5. I imagine that's why they cleared her. Considering the circumstances, however, I would not have done so. Somebody was going "by the book" and the book needs to be questioned in situations like this, not held up as the be-all-end-all. While I'm sure there are hospitals that aren't ready, I'm also sure there are hospitals that are ready. Thing is, all of them have to get ready! Why should they have cleared her? Nancy Snyderman doesn't even have a fever and she is under mandatory quarantine. But the cdc clears this woman to fly? Makes no sense to me Did you read what I typed, MT? Did I say they should have cleared her? No. I didn't. I said, quite clearly, I would not have done so.
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Post by Miss Tequila on Oct 15, 2014 21:06:30 GMT -5
Why should they have cleared her? Nancy Snyderman doesn't even have a fever and she is under mandatory quarantine. But the cdc clears this woman to fly? Makes no sense to me Did you read what I typed, MT? Did I say they should have cleared her? No. I didn't. I said, quite clearly, I would not have done so. You said they were "by the book". What book would clear a person who was exposed to Ebola? The head if the cdc said she never should have flown. I was questioning why you think they were "by the bookl when their own director said she shouldn't have flown.
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Joined: Dec 25, 2010 18:13:34 GMT -5
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Post by mmhmm on Oct 15, 2014 21:11:53 GMT -5
"The book" I'm talking about is "the book" that defines what is to be considered a "fever". Practice is anything under 100.4 is not considered a "fever". That should have been put aside in the current situation; however, whoever advised this woman she could fly was going by that practice without thinking it through. As I said, and will repeat: She SHOULD NOT have been cleared to fly.
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EVT1
Junior Associate
Joined: Dec 30, 2010 16:22:42 GMT -5
Posts: 8,596
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Post by EVT1 on Oct 15, 2014 21:34:38 GMT -5
right. depending on what the situation calls for. if there are fluids splashing all over the place, or you have injuries on your neck, FACE SHIELD. if not, GOGGLES. same deal in the shop. if you are working on a belt sander, your odds of getting something in the neck are nil, pretty much. goggles are the requirement, there. the CDC is not going to micromanage your hospital for you. they are not going to tell you specifically what to wear, and when to wear it. they are going to issue RECOMMENDATIONS, and defer to BEST PRACTICES. seriously, i think that we are making way too much of the CDC's roll here. if they told the hospitals to wear $1M pressure suits with hepa filntration systems and breathing systems, i am sure those would be quite safe. but i am also sure that protecting your eyes is also quite safe under normal circumstances. my point was that if you read through the CDC SUGGESTIONS, they address every single one of the objections that FOX News raised. what ever happened to personal responsibility? The hospitals are not prepared for Ebola. The CDC is incompetent and the director needs to be fired. Turns out the nurse called the cdc and they cleared her to fly. This is one big clusterfuck. Thank god it isn't airborne because with the shit show going on we would all be in serious trouble BULLSHIT! The CDC has issued protocols on this- it is the hospitals and other private industries that are charged with following them. If they do not- it is not on the government.
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