Tuesday, October 14, 2014

Icons From the Age of Anxiety : Ebola: Landmark Outbreak in Dallas,Texas, USA

Ebola has broken out in the heart of the city I live in. As you might imagine it's an especially fearsome contagious disease for someone with OCD or other anxiety disorders. And for those "neurotypical" persons suffering recurrent rumination filled with irrational fear and loathing -- welcome to a bitter taste of the OCD experience. Anyway, without being overly alarmist, at the bottom of this post is some official information regarding disinfectants that some in Dallas may find helpful in the uncertain days ahead...

Nurses at a nationwide convention in Las Vegas staged a "die in" to dramatize the USA's lack of medical preparation and training for an Ebola outbreak. "It's not 'if,' but  'when'," they said. A Nevada healthcare official stated that such an Ebola outbreak was "extremely unlikely" to occur any time soon in the USA, and so, he was far more concerned about the spread of venereal disease in Sin City. The very next day, the nurses were proven correct on all counts when a Liberian visitor brought the contagion to Dallas.


Officials held news conferences and officials reassured the public that they were confident that they could halt any Ebola outbreak in its tracks. While they stressed that only close direct contact with "bodily fluids" from the afflicted could transmit the disease -- and thus it was "low risk" for the public. The hazmat suits worn by clean-up crews soon suggested otherwise -- that the virus could indeed linger in the environment and be very contagious.

Although told to quarantine themselves for a "wait and watch" self-monitoring period of 21 days, the family defied this request, showed an alarming lack of personal responsibilityand sent at least one "high risk" child, and possibly more, into public schools the following day. The need to socialize is a human trait that is hard to override long-term -- but this was the very next day.

Then, unfortunately, an intensive care nurse treating the Liberian patient came down with the virus, even though she was wearing protective gear. Once again, those demonstrating nurses in Las Vegas were proven correct in their warnings. A "break in protocol" was cited as the reason for the new case -- but no one has yet explained exactly what this "break" was. The apartment at the new Lakewood area location in Dallas was isolated and special cleaning crews were sent in. The nurse sought treatment and went into quarantine at the hospital within 90 minutes of being symptomatic.


The Dallas nurse's pet dog was also quarantined (at another location) as all mammals may act as carriers for the deadly disease. The pet dog of a case in Spain (another nurse) was recently euthanized as a public health precaution, despite pleas from the pet-loving public. It has not been explained how or even if such pets can be monitored with test for symptoms.

Hazmat crews arrived once again to disinfect the second apartment, and police are guarding it to make sure no one enters the building. TV news crews are still lingering around the site after several days, possibly to film "location shots" for their news updates. Ebola factoid flyers were issued to homeowners in the area in an attempt to ease fears. Only one "high risk" contact with the nurse was identified, and that person is also being monitored.


Chlorine Bleach: A Trusted Ally in the Battle against Ebola

By the Water Quality and Health Council, October 10, 2014

A group of San Diego women with close ties to the West African nation of Liberia is raising funds to help fight the Ebola outbreak in that country. Their chosen weapon:  buckets of bleach.  In a recent video, Deborah Lindholm, the founder of the group, Foundation for Women, describes life today in Liberia:  “There are no handshakes, no touching, no hugging; there is just complete and utter fear in Liberia right now…There are buckets of bleach all over the streets in Liberia and the people in Liberia and in the surrounding areas that have been affected by Ebola understand that if they keep their hands clean they can kill off the virus.

Hand washing is an extremely important component of infection control as germs picked up on the hands are readily transferred to the eyes, mouth and nose by touching.  

Keeping all settings clean—homes, healthcare settings, schools and workplaces—is another critical factor in infection control because it helps prevent hands becoming re-contaminated between hand washings.

Thousands of gallons of concentrated chlorine bleach and other critical equipment are loaded into the cargo hold of an airplane destined for Sierra Leone, September, 2014. 

World Vision and the American Chemistry Council coordinated the humanitarian airlift to help fight Ebola.  Chlorine bleach was donated by Olin Corporation; domestic transportation services for bleach were donated by CSX Corporation and the Buffalo and Pittsburgh Railroad; bleach bottling services were donated by The James Austin Company.

Using Bleach to Destroy Ebola on Surfaces

According to the World Health Organization (WHO), “The Ebola virus can be eliminated relatively easily from surfaces using heat, alcohol-based products, and sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder) at appropriate concentrations.” 

The Ebola virus can live on inanimate surfaces, especially those that are soiled with blood or other body fluids from infected people.  In the later stages of Ebola, when patients experience internal and external bleeding, they may vomit blood or have bloody diarrhea, all potential sources of infection for those around them.

WHO recommends surfaces or objects contaminated with blood, other body fluids, secretions or excretions from Ebola patients be cleaned and disinfected as quickly as possible. 

The following information on bleach use against Ebola is based on a September, 2014 WHO guidance document:

As soon as possible after a spill of bodily fluids, clean the affected surface with a standard hospital detergent; then apply disinfectant.  This order of operations helps prevent the disinfectant becoming inactivated by organic matter on surfaces.
A 0.5% chlorine solution or a solution containing 5,000 parts per million free available chlorine is an effective surface disinfectant against Ebola.  

To prepare such a solution from liquid chlorine bleach or solid calcium hypochlorite, follow the directions in Examples I and II below.  Note that chlorine solutions have a limited shelf life, and should be prepared fresh daily.

Wastes, such as feces, urine, vomit and liquid waste from washing can be disposed of in the sanitary sewer or pit latrine with no further treatment.  WHO provides detailed guidance on Waste Management Procedures.

Don’t use bleach for everything: If an uninfected person is splashed with the bodily fluid of an infected person, as soon as possible wash the affected skin surface with soap and water.  

If a mucous membrane is exposed to infected bodily fluid, as soon as possible irrigate with copious amounts of water or an eyewash solution, not with chlorine solutions or other disinfectants.






 Bleach:  A Trusted Ally

In the rapidly unfolding saga of the West African Ebola outbreak, the critical role of surface disinfection is highlighted repeatedly by public health professionals along with public education, isolation and quarantine, contact tracing, good hygiene and personal responsibility.  

From sanitizing healthcare environments used for Ebola patient care, to airplanes used for international travel, to homes formerly inhabited by Ebola patients, chlorine bleach proves time and again to be a trusted ally in the raging battle against Ebola.

For further information on Ebola, please see the Centers for Disease Control and Prevention website and our article Ebola:  What You Should Know.

Notes:

1. Disinfectants are defined by EPA as either hospital or general use types. Disinfectants destroy or irreversibly inactivate infectious fungi and bacteria, but not necessarily their spores.

2. Chlorine solutions of various concentrations are also recommended for machine-laundering contaminated linens, decontaminating equipment such as goggles and visors and even body bags containing Ebola victims.


In contrast to the above advice, a journalist covering the devastating West African Ebola outbreak, rather than using just soap and water, keeps a bucket of 0.5% bleach solution in her own apartment to disinfect her hands when she comes inside.
Here is the West African Ebola journalist's own caption for her photograph of her personal chlorine cleansing solution.


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