September 5th, 2014

lotus

вирус эбола- новые смерти, и ситуация в Нигерии

ну вот, еще пару дней назад, на сайте ВОЗ были цифры примерно 4 дневной давности.
на 5 сентября, по данным ВОЗ, если обобщить по странам африки, 4 тыс больных и 2100 умерших.
The deadly virus has claimed 2,097 lives out of 3,944 people infected in Liberia, Guinea and Sierra Leone, since emerging last December, the UN's health organ said after a two-day crisis meeting in Geneva.
Nigeria has recorded another eight deaths out of 22 cases.

At least 30 more people have died in a separate outbreak in the Democratic Republic of Congo.
стремительное развитие,
к тому же в Нигерии ожидается серьезная вспышка- было очень много контактов (несколько сотен, из которых 60 в группе высокого риска) в Портакоте, с зараженным врачом.- кстати- то, что он болен эбола, подтвердилсь примерно через недел. после его смерти (через 17 дней после начала заболевания).
так что и скорость, и оперативность, качество определения заболевания лабораторно - оставляют желать лучшего.[читаем далее, ситуация в Нигерии, Nigeria, Port Harcourt, WHO, English]

One close contact of the Lagos case fled the city, where he was under quarantine, to seek treatment in Port Harcourt.

The close contact was treated, from 1 to 3 August, at a Port Harcourt hotel, by what would turn out to be the city’s index case. This case was a male physician who developed symptoms of weakness and fever on 11 August and died of Ebola on 22 August. His infection was confirmed on 27 August by the virology laboratory at Lagos University Teaching Hospital.

The male physician in Port Harcourt is therefore indirectly linked to Nigeria’s first case.

The case history of the index case in Port Harcourt is important, as it reveals multiple high-risk opportunities for transmission of the virus to others.

After onset of symptoms, on 11 August, and until 13 August, the physician continued to treat patients at his private clinic, and operated on at least two. On 13 August, his symptoms worsened; he stayed at home and was hospitalized on 16 August.

Prior to hospitalization, the physician had numerous contacts with the community, as relatives and friends visited his home to celebrate the birth of a baby.

Once hospitalized, he again had numerous contacts with the community, as members of his church visited to perform a healing ritual said to involve the laying on of hands. During his 6 day period of hospitalization, he was attended by the majority of the hospital’s health care staff.

On 21 August, he was taken to an ultrasound clinic, where 2 physicians performed an abdominal scan. He died the next day.

The additional 2 confirmed cases are his wife, also a doctor, and a patient at the same hospital where he was treated. Additional staff at the hospital are undergoing tests.

Given these multiple high-risk exposure opportunities, the outbreak of Ebola virus disease in Port Harcourt has the potential to grow larger and spread faster than the one in Lagos.
Nigerian health workers and WHO epidemiologists are monitoring more than 200 contacts. Of these, around 60 are considered to have had high-risk or very high-risk exposure.

The highest-risk exposures occurred in family members and in health care workers and patients at the facility where the index case was hospitalized. Church members who visited the index case while he was hospitalized are also considered at high risk.
lotus

вирус эбола- очередной американский пациент

в сша прибыл на лечение от лихорадки эбола американский врач-миссионер (из либерии). прибыл он в небраску, омаху (не в атланту, джорджию, как предыдущие двое)- там находится крупнейшее из 4 имеющихся инфекционных отделений в сша- аж на 10 койко-мест!
состояние больного стабильное, средней тяжести.

"Dr. Rick Sacra, 51, is being treated at a 10-bed special isolation unit, the largest of the United States' four. It was built to handle patients with highly infectious and deadly diseases, according to Dr. Mark Rupp, chief of the infectious diseases division at the center.
Sacra— the third American aid worker sickened with the virus — arrived at 6:38 a.m. Friday at the Omaha hospital. Sacra was wheeled on a gurney off the plane at Offutt Air Force Base, transferred to an ambulance and then wheeled into the hospital, said Rosanna Morris, chief nursing officer for the medical center.
Sacra was conscious Friday and was able to communicate with medical staff.
Sacra came to Omaha instead of Atlanta because the U.S. Department of Health asked the medical center to treat him in order to prepare other biocontainment units to take more ebola patients if needed.

Sacra, a doctor from suburban Boston who spent 15 years working at the Liberia hospital where he fell ill, said he felt compelled to return after hearing that two other missionaries with the North Carolina-based charity SIM with whom he'd worked were sick. He delivered babies at the hospital, and was not involved in the treatment of Ebola patients, so it's unclear how he became infected with the virus that has killed about 1,900 people.

Dr. Phil Smith, medical director of the Omaha unit, has said a team of 35 doctors, nurses and other medical staffers will provide Sacra with basic care, including ensuring he is hydrated and keeping his vital signs stable.

кто скажет, что это обычно, чтобы команда из 35 медслужащих, обеспечивала базовые нужды одного инфекционнго больного в сша?
сможет ли страна себе позволить такую заботу, если случаи больных лихорадкой эбола участятся?

при таком количестве инфекционок достаточно уровня (4!), сша, конечно, "готова", если вдруг что.

можно конечно говорить, что в сша все круто с медобслуживанием, дезинфекция, уборка, стерилизация, обратное давление в госпиталях, одноразовые шприцы и халаты, итд итп.
но при этом не забывать, что внутрибольничные инфекции- распространены в сша, не смотря на методы дезинфекции- стерилизации, и одноразовость, и краткие сроки пребывания больных в госпиталях.
и что убрать-дезинфицировать палату, полностью, после одного пациента перед вторым, включая туалет -душевую, и перестелить постель- нянечке "выделяется" минут 15 времени ( в обычной больнице). и что гость-посетитель может свободно прийти в палату, в чем есть, и уйти (ну кроме операционной) так же. и что врач (медсестра) в рабочей одежде и обуви может пойти на ланч, в магазин или домой после работы. это "обыденность".

лечить Dr. Rick Sacra в Омахе предполагается "поддерживающими методами", симптоматично, так как лекарств нет.
10 имеющихся курсов лечения ЗидМаппом уже израсходованы на 10 больных в сша других странах, и в 3 случаях больные выжили.
ZMapp has been given to about 10 infected health workers, including Americans and Europeans, of whom three recovered.

предполагается, что реален вариант попросить крови у выживших после лихорадки, так как кровь с антителами переболевших более-менее эффективна.
"Rupp said he's unaware whether Brantley and Writebol have been asked about donating blood serum for Sacra.
"These folks are friendly and know one another, and they would presumably be willing to help their compatriots," Rupp said, adding a battery of tests must first be performed, including one to ensure that any blood serum is compatible with Sacra's blood type."