Ebola news: Salia, Hickox
Last night when I heard that Dr. Martin Salia, a Sierra Leone native who is married to a US citizen and who contacted ebola while treating patients in his native country, had been flown here for treatment and was in “very critical” condition, I thought “boy, if we can cure him, then American medicine is really onto something in the treatment of ebola.”
Sadly, it was not to be: Dr. Salia has died of the disease. He was very very far gone when he arrived:
“He was placed on dialysis, a ventilator and multiple medications to support his organ systems in an effort to help his body fight the disease. He also received a dose of convalescent plasma and ZMapp therapy was initiated on Saturday,” the hospital said in a statement.
“We used every possible treatment available to give Dr. Salia every possible opportunity for survival,” Smith said. “As we have learned, early treatment with these patients is essential. In Dr. Salia’s case, his disease was already extremely advanced by the time he came here for treatment.”
Regular readers here know that I’ve written a great deal about ebola and in the process I’ve learned quite a bit about it. So based on that prior research I’m highlighting two very salient facts about Dr. Salia. The first is that he never knew how he got ebola; he was a general surgeon in Sierra Leone and was not specifically treating ebola patients. This reflects something I learned a while ago and have written about before: that ebola is not always easy to spot, even for medical personnel who are well-versed in its diagnosis and are treating patients in areas where it is endemic, and therefore would be on high alert for it. That is one of the many many dangers of the disease, and you may recall that the same thing happened with Dr. Rick Sacra, who was treated here much earlier in the disease’s course than Salia and has survived.
The second thing I’d like to highlight is that it took four (or five; I’ve read differing accounts) full days after Dr. Salia first showed ebola symptoms for his blood test to become positive for the disease. By that time he was extremely sick indeed. The loss of those days of possible treatment here may have made a big difference. Here is the story:
When Martin Salia’s Ebola test came back negative, his friends and colleagues threw their arms around him. They shook his hand. They patted him on the back. They removed their protective gear and cried.
But when his symptoms remained nearly a week later, Salia took another test, on Nov. 10. This one came back positive, sending the Sierra Leonean doctor with ties to Maryland on a desperate, belated quest for treatment and forcing the colleagues who had embraced him into quarantine.
We were celebrating. If the test says you are Ebola-free, we assume you are Ebola-free,” said Komba Songu M’Briwa, who cared for Salia at the Hastings Ebola Treatment Center in Freetown. “Then everything fell apart.”…
The doctors who tended to him in Freetown appeared to be unaware that an early Ebola test ”” taken within the first three days of the illness ”” is often inconclusive. In a country where information about the disease continues to move slowly, it was another potentially tragic mistake.
In many cases, a negative test at that stage means nothing because “there aren’t enough copies of the virus in the blood for the test to pick up,” said Ermias Belay, the head of the CDC’s Ebola response team in Sierra Leone.
As Dr.Salia worsened, he assumed he had malaria, as many with ebola in Africa do (think again of Thomas Duncan, who thought the woman he helped had either malaria or pregnancy complications, and relied on that—and he was just a layman). Dr. Salia prescribed malaria medication for himself, but it didn’t help:
He [then] called his colleague Alhali Osman Smith, who worked with him at Freetown’s Kissy United Methodist Hospital.
“He told me he thought he still might have Ebola,” Smith said, “in spite of what the test said.”
RIP, Dr. Salia.
Which brings us to the latest from the arrogant, offensive Kaci Hickox, who asks us to stop calling her “the ebola nurse”:
I never had Ebola. I never had symptoms of Ebola. I tested negative for Ebola the first night I stayed in New Jersey governor Chris Christie’s private prison in Newark. I am now past the incubation period ”“ meaning that I will not develop symptoms of Ebola.
I never had Ebola, so please stop calling me “the Ebola Nurse” ”“ now!
Love that tone, don’t you? I, for one, never called Hickox the ebola nurse. In fact, I went so far as to call her “America’s sweetheart,” but do I get any thanks? No!
I’ve already pointed out many things about Ms. Hickox, one of them being that it’s surprising that, although she’s a public health nurse, she doesn’t seem to understand the very concept of quarantine. Nor does she seem to understand that (a) she initially appeared to have a major symptom of early ebola, a fever; (b) she had just returned from treating ebola patients; and (c) her negative blood test that night was meaningless, as the story of Dr. Salia demonstrates all too graphically.
Hickox really isn’t the ebola nurse; for one thing, she hasn’t demonstrated that much knowledge about the disease. But she just might be the most detested nurse in America right now.
hey, let’s keep calling her the Ebola Nurse !
Just to piss her off !!!
It’s the same logic people apply to that civil rights activist in Fort Lauderdale who keeps getting arrested for flouting public safety laws while providing food for the homeless:
“I’m doing charity work, so I should be exempt from the rules.”
Or, more simply, “Good intentions trump everything,” which of course is a core liberal mantra.
The irony of the destination to which they are ferociously paving a road completely escapes every one of them.
They are worse than symptoms of ebola, they are Leftists working on their cheap grace in Africa, but didn’t look like they did much work on the real problem.
Kaci’s also not very happy with how the Canadian government is handling things:
Don’t think the Canadians are feeling the love — at least those commenting on the article sure aren’t. But she’s got The Guardian crowd in her corner!
I love the cognitive dissonance between politeness and arrogance, all in the same sentence:
“Please stop calling me the Ebola Nurse — now!”
It’s the equivalent of a lieutenant asking a private: “Hey George, could you please lend me ten dollars? That’s an order.”
Clearly, Ms. Hickox has a lot to learn — in terms of what quarantine means, and what common courtesy means, and what an unearned sense of entitlement means.
She KNOWS what she knows, and we don’t, so clearly she is smarter than us. The Liberal view.
My question, which I’ve asked elsewhere and has never been answered, is: What was Hickox in fact doing over there? She wasn’t, so far as anyone has said, actually a volunteer and treating patients — she was and continues to be employed by the CDC as an epidemic information specialist, that is, a bureaucrat. A paper-shuffler. They track the paper records of the patients and treatments and hospitals and M&M info for bureaucratic outfits like CDC which themselves have no foreign treatment remit whatsoever. CDC CAN’T send its employees anywhere to bust in and start treating people and running treatment programs (as that twit Frieden keeps explaining) — so what was Hickox actually over there to do? If all she was doing was paper-shuffling analysis, and she let everyone assume she was Hero Nurse, that’s pretty cheesey, but it kind of explains why she was SO damn sure she couldn’t possibly have any chance of infection — she didn’t have any patient contact at all. Of course, explaining that would sort of diminish the Hero Nurse halo thing, and she was working that for all it was worth for a while … I don’t know this, you understand, that’s why I’m asking. But she IS a CDC employee, and was never described as any kind of volunteer doing bedside treatment, so it’s always struck me as odd that she could be so absolutely sure she was uninfectable, especially when a nurse in her living quarters came down with Ebola and died of it.
I agree we should not use “Ebola Nurse” – too non-specific. Let’s go with Ebola Kaci.
Do we actually know what she did in Africa? Her initial insistence that she had no symptoms and was therefore not infected is at odds with what we know about the initial phases of the disease, poor Dr. Salia being the latest example. I suspect she was only in an administrative role and was not actively soothing the fevered brows of dying Ebola patients and swabbing up virus-laden body fluids.
Megaera:
Well, according to this she had contact with ebola patients. It’s not clear whether this constituted the bulk of her work there or not.
Steve S:
See my comment right above this one.
One more thing we know, treatment for malaria is completely unhelpful with Ebola! RIP Dr.
I tested negative for Ebola the first night
Yes, Ebola Nurse is not exactly impressing anyone who understands the disease with this little statement. It doesn’t mean a damn thing except it’s early in the disease (if she had had it). If she has to insert herself into the public, it would be nice if she wouldn’t spread complete misinformation at the same time.
Kaci elaborates a bit more on the work she did in this interview with the Portland Press Herald:
“She was frustrated because the protective gear she had to wear — ‘this sort of space suit’ — made it hard to connect with patients, and the high temperatures inside meant she could only spend an hour at a time in the high-risk tent, which didn’t leave much time to provide care for the 30 or so patients in her care.”
Portland Press herald must be a lefty paper. Nurses with MSN degrees don t do *grunt work* & caring for 30,! 30! people with vomiting & diarrhea is physically impossible. Most likely those 30 patients of hers needed their histories & contacts compiled. LOL
Interesting. The article says she volunteered for MSF, but her own internet (I think Facebook) information, which she has now taken down, stated that she had applied to MSF and had not made the cut at which point she went to work for CDC, training as an EIS. Hasn’t mentioned anywhere leaving CDC, either. And didn’t say anything about a volunteer stint. Wonder what her employment status really is? Civil Service doesn’t usually let you go freewheeling off on this sort of frolic and detour, and if I were her bosses I wouldn’t be happy with the kind of public attention she was drawing, but for such a talky sort she’s being remarkably close-mouthed about that. Hm.
Megaera Says:
November 17th, 2014 at 5:40 pm
She ultimately WAS able to work under the aegis of MSF – Doctors without Borders.
She was rejected much earlier, before she picked up additional degrees/ certification.
Without a doubt the CDC gave her permission to work — short term — in west Africa. Think of the politics. (Barry)
Exponential growth is common in nature. What makes a virus hard to grasp is just how intense its tempo is.
1::100::10,000::1,000,000 etc.
That tempo is way above bacteria.
1::2::4::8::16 etc.
The other factor is that the slope of any exponential is itself an exponential. In the case of viral replication victims go from having mild symptoms to severe distress at extreme speed.
This is why you constantly read of astonishing events during viral pandemics. For a population without immune defenses, a pandemic virus not only gets everywhere — it does so at lightning speed — far faster than any medical counter-action.
The Spanish wrote of finding a massive native nation across the greater American south. The exploration party had to leave behind one sick man, too ill to travel. When another Spanish party returned, some years later, the ENTIRE native nation was gone. Eventually it was discovered that the single Spaniard had spread (small pox?) his disease through a population of millions.
This pandemic was the reason why American colonists found so few native Americans in the 18th Century in the south. Every Indian tribe to speak of had moved in during the last two hundred years. Here and there, digs are finding evidence of the massive civilization that had gone before.
&&&&
It’s the verticality of viral expansion that has to put one on guard. Ones infection threshold leaps with every passing hour.
Ebola is plainly a virus that we, largely, have no immunity from. What happened four centuries ago can strike at any time.
Paradoxically, the more sophisticated the state of medicine the more rapid and devastating the propagation. Hospitals become transmission nodes!
It’s essential that highly contagious viruses NEVER be brought into ordinary hospitals/ clinics/ ERs. Such events ruin the utility of those facilities — and they are needed — while not conferring any benefit to those infected.
This folly/ error is exactly why ebola R E A L L Y got rolling in west Africa. You’ll note that the locals stopped coming to their hospitals — and the ebola epidemic suddenly faded back!
The reason is patent: the hospitals were THE transmission nodes.
It also explains why so many doctors and nurses, percentage-wise, were cut down.
During such epidemics, totally separate facilities are required. That includes response vehicles and the talent.
This is possible on short notice because any virus is a one-trick pony, so that only a minor subset of medical gear and knowledge is needed. You actually don’t need doctors to speak of, nurses aplenty, yes.
If you don’t want your medical system to crash: keep your doctors well away from the viral blast zone. They’re sure to suffer enough as it is — by asymptomatic viral victims.
It is the height of arrogance to think that Americans will respond significantly differently than west Africans. The virus doesn’t even know we’re Americans, in the first place. It’s just going to do its thing.
Dr. Salia’s situation is an interesting contrast. But not much to say on that one.
Neo,
Dr Brantly was on his deathbed and pulled through. Wouldn’t you think it’s a little premature to conclude that early treatment is the key? There really haven’t been many people for us to observe. Seems like there’s a higher mortality rate for blacks from what we’ve seen. Kind of weird. That said, early treatment surely can’t hurt.
Kaci Hickox will be The Ebola Nurse all her miserable self-centered life.
southpaw:
Even in Africa, studies indicate early treatment confers an advantage, although not a huge advantage. This was prior to any ebola patients coming here for treatment.
And no, I don’t think it’s too soon to at least begin to believe that early treatment counts, although of course the “n” for treatment in this country is very very small.
For example, of the people treated in the west, in Spain there were two priests flown there when they were already in dire straits and they died. The nurse, who was treated very early, lived.
In the US, Brantly and Writebol were very sick when they got here for treatment, and Duncan of course had gotten quite ill before he was admitted to the hospital. Duncan was the only patient who died in the US, until Salia (who also experienced a marked delay in diagnosis and treatment). So the death toll in Spain for people treated late was 100%. The death toll in the US for people treated late is 50%. And the death toll in the US and Spain for people treated early (or relatively early) is 0%. I would say the preliminary figures for treatment in the west indicate that early treatment could be very very important.
This is Nancy Writepol’s opinion about early treatment and its importance even in Africa:
The MSM is pushing “Ebola Kaci”s case as proof that the CDC knows what it’s doing, and quarantine is only necessary when there’s “sufficient reason” to believe the subject may have been infected.
An newspaper article from a couple days ago was headlined something to the effect of “Ebola-free nurse proves CDC is correct on quarantine” (I’ve already tossed it, so can’t find the exact wording).
The Almighty spared us a disaster, and the CDC takes the credit.
Hickox just doesn’t get it. Countless other medical professionals returning from Africa quietly self-quarantined themselves and didn’t crow about being disease-free afterwards.
I don’t know if she is a government prop/mouthpiece or simply just an arrogant loudmouth. One thing I believe is certain is that she was never in close proximity to anyone with the ebola virus in Africa, no matter what anecdotes she spouts off. Thus, she was sure all along that she wouldn’t be testing positive. Also, she couldn’t admit to this because she would lose a lot of the “good person points” that go along with treating ebola victims in Africa.
“This reflects something I learned a while ago and have written about before: that Ebola is not always easy to spot, even for medical personnel who are well-versed in its diagnosis and are treating patients in areas where it is endemic, and therefore would be on high alert for it.”
This is somewhat of a rant and while both deaths are tragic and regrettable, I feel more annoyed by the 1st one.
Somewhat ironic as this doctor’s family will receive nothing but Tomas Duncan’s family will receive a nice payday in West Africa along with having a Foundation set up in memory of Mr. Duncan and managed by his nephew in the US.
I know some readers think Mr. Duncan was faultless in this tragedy. If the medical professionals that work with Ebola are not that keen on spotting the signs, why would you think a hospital intake person, would be able to spot the symptoms?
“The family of the only patient to die of Ebola in the US has received an undisclosed sum from the hospital that treated him, their lawyer has said. Officials at Texas Health Presbyterian have admitted their mistake when they sent Thomas Eric Duncan home despite his symptoms and travel history.”
“Lawyer Les Weisbrod said the sum was a “very good deal” and would provide for Duncan’s parents and his four children. A foundation in his name will also be set up to fight Ebola in West Africa.”
“The hospital settled with members of Duncan’s family for an undisclosed sum, as the Associated Press reported, and will also create a charitable organization in his name. The Los Angeles Times pointed out that “Texas caps malpractice awards for pain and suffering against a physician at $250,000 and damages against hospitals at $250,000 per hospital.”
So Mr. Duncan’s kids and parents will live lavishly in West Africa while the wife and children of US doctor will have to survive on whatever plans he had made for his family.
Somehow that doesn’t see equitable but then what do I know? In the end it is the taxpayer that gets it in the rump. The $600k medical expense for Mr. Duncan, the $500k payout to his family and the $$ cost to treat the 2 nurses that were infected will be paid by the working ants, not the grasshoppers nor those that lord it over us.
I know this sounds harsh to some of you but it is what I feel. It would have been nice if Mr. Duncan would have just stayed in Africa or if we would have simply closed our borders to those traveling from West Africa.
If Nebraskans couldn’t save the life of Dr. Salia, there was no hope at all.
Here in Omaha it is amazing how the news coverage has declined from the first case to the third.
Now back to reporting the weather (constantly), the daily shootings and the Cornhuskers.
Mike:
You might also ask, if experts sometimes have trouble spotting the signs, why so many people believe that Duncan of course knew Marthalene Williams had ebola, even if her parents didn’t know, the neighbors didn’t know, she did not have any of the classic signs of ebola except a fever, and the clinic to which she was brought told them she had malaria.
Note, also, that, although ebola CAN be difficult to recognize or diagnose (as I wrote: “not always easy to spot”), especially in early stages, and most particularly when the only symptom is a fever, it is not ALWAYS difficult to diagnose. Note also that medical personnel did in fact suspect that Salia might have ebola from his symptoms, because they did a blood test on him. It was the negative blood test that threw them off the trail and delayed his diagnosis.
In contrast, Duncan’s case was a no-brainer on his first visit. The hospital knew: had come from Africa, he had a “sharp” headache, his fever was 103 while being tested, and he had severe (8 on a scale of 1 to 10) abdominal pain. These are classic symptoms of ebola, and he should have been tested. Instead, it was not even considered as a possibility. There was no negative blood test to throw them off because there was not even a blood test given or contemplated.
If Duncan had merely had a fever, the situation would not have been as clearcut. Nor, by the way, did the doctors even for a moment suspect the possible differential diagnosis of malaria. Malaria is a reportable disease in the US, by the way.
Dallas Presbyterian was negligent.
I’d like the Judge that sided with Hickox to comment on the news about Dr Salia.
I know this sounds harsh to some of you but it is what I feel.
It is true, for the most part. Mostly because the Leftist Regime is what it is, evil. It all flows down hill from there. Everything can be routed back to the Original Source.
Instead, it was not even considered as a possibility.
Because it was the first case of the disease in the US. Ever. Contrary to popular believe, not every front line medical center person in the country is paying close attention to emerging diseases in other countries.
I’ll note that the lady with Marburg was never diagnosed with it, throughout her illness and only found out many years later after she had recovered.
Lea:
Even I would have been aware of ebola as a possibility if someone said he/she had come from Africa, and with symptoms even remotely like that. And I’m not a medical person. Ebola had been big news since the summer.
There is no excuse.