The Emperor’s New PPE

By Sally Sellers

SallyAnnSellersSally Speak is the effort of Sally Ann Sellers, RN, BSN, MA Ed, an old battle-ax who is just delusional enough to think her pen is mightier than a sword. Good night & good luck!

“There is no greater evil than men’s failure to consult and to consider.” ― Sophocles, Antigone

Hospitals in the US cause about 400,000 premature patient deaths each year due to preventable harm (iatrogenic causes). This equates to three jumbo jets falling out of the sky each day (James, 2013). Our dysfunctional healthcare system tolerates the carnage of preventable patient injury and death, and potential occupationally-acquired infectious diseases by healthcare workers (HCW). But with the introduction of Ebola Virus Disease (EVD), we may be creating unsafe conditions that threaten communities outside of the hospital walls if our isolation protocols and personal protective equipment (PPE) do not work properly. This deadly problem may add to the list of poor outcomes of our healthcare system, spreading the disease, since caregivers are vulnerable to being infected and carrying it into communities. In West Africa, as of mid-October, WHO reports 420 HCW cases of EVD, and 239 deaths, and 2 HCW cases in the US and 1 in Spain.

The deadly outbreak of EVD has created the need for change within the U.S. healthcare system, but the leadership at the CDC and other healthcare in-groups are reacting slowly, with groupthink, creating a situation where those who set policies actively suppress dissenting viewpoints, isolating themselves from outside influences and even taking irrational stances that dehumanize other outside groups, such as “sloppy nurses” and a “panicky public.” When groups make faulty decisions that lead to a deterioration of mental efficiency, reality-testing or moral judgment, they are displaying symptoms of “Groupthink”, a term coined by social psychologist Irving Janis in 1972. What are the signs of groupthink, and how do those signs present during a crisis when we need to change healthcare standards and policies?
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Clutching our world views with a death grip

By Mary Odum

As I write, I am sitting in what might be my last airplane seat, stacked cheek to jowl with a couple with a cute but runny-nosed baby. My trip was with girlfriends on a bike tour in California, and I made the most of it, living very much in the moment. As I traveled, I wore my infection control hat, scanning the settings with new eyes for potentially dangerous situations. I was careful in public places such as airports, trolleys, and the BART, washing my hands frequently and keeping them folded in front of me. I was much more aware of impulses to touch my face. I watched a couple in the San Francisco airport who were headed to Nairobi touch their faces, many times, as they waited. Airport bathrooms were mostly hands-free, but the automatic toilets sprayed their contents powerfully in all directions when flushed. There was a new sign in the TSA line warning us to wash our hands because of Middle East Respiratory Syndrome (MERS), but no mention of Ebola (EVD). TSA used gloves to pat me down, but they were not washing their hands after contact with people. Boarding passes, drivers licenses, and credit cards were swiped and exchanged, along with bills and coins. I saw a large homeless population on the waterfront in San Francisco with no access to bathrooms or handwashing, who were using the streets as open latrines. I saw prostitutes. Hotels had carpets and mattresses that would defy cleaning in an outbreak. I saw people hugging, and shaking hands, and doing all kinds of human, caring, or even loving things that would be extinguished in a pandemic.

Today the first nurse within the US healthcare system has acquired EVD. My nursing friends are worried. Are we ready for this? How do we communicate risk, or should we settle for optimistic reassurance that our system can handle this? What are our biggest needs in preparation?
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Uncharted territory for a system in overshoot

By Mary Odum

http-:www.flu.gov:planning-preparedness:community:community_mitigation.pdf-fig3a
http-:www.flu.gov:planning-preparedness:community:community_mitigation.pdf 1918 pandemic CFR = <3%. Where would Ebola’s CFR line be on this graph?

We are in uncharted territory with the Ebola virus disease (EVD). The last time we had a plague that was this deadly was the Black Death in the 14th century, when there were only 450 million people in the world. That pandemic killed 30% to 70% of the population. There is no benchmark for EVD, which kills 3 out of 4 people it touches, and is emerging into a global population of 7 billion.

Ulgiati et al., 2011, Emergy-based complexity measures in natural and social systems - Emergy flows plateau in modern Rome as an example of a high-transformity system
(Ulgiati, Ascione, Zucaro & Campanella, 2011, Fig. 1) Emergy-based complexity measures in natural and social systems – Emergy flows plateau in modern Rome as an example of a high-transformity system

This pandemic signifies a turning point for society in response to peak oil, highlighting the problem of globalization for a planet of 7 billion people. We have lost control of a deadly outbreak, and our responses to its exponential growth are linear at best, ensuring that this plague will most likely spread further. Many in first world countries think we are immune to plagues. How might transmission of EVD change as it moves from a low-resource or low-transformity setting in West Africa to resource-rich (high-transformity) countries?  How might the battle against this epidemic change as it breaks out into different environments?

Continue reading Uncharted territory for a system in overshoot

The 4S’s of surge capacity

By Mary Odum

Welcome to the arcane and short-sighted world of public health strategic planning. This post introduces the term surge capacity, a term we will hear often in the coming months of this growing Ebola (EVD) epidemic. Surge capacity is the ability to manage sudden or prolonged increases in overall healthcare demand, and the key components are the 4 S’s of staff, stuff, structure and systems, for hospital and community preparedness (Adams, 2009). During a pandemic, lack of surge capacity in all four of these areas become key limiting factors:  hospital isolation beds (structure), healthcare providers (HCP-staff), isolation gear (stuff), and an efficient, just-in-time, high-transformity system, which is an obstacle to resilience.  Continue reading The 4S’s of surge capacity

Ebola as a game-changer?

By Mary Odum

In crises, anxiety focuses attention. I continue to focus on the growing Ebola epidemic, which has no real restraints to keep it from becoming a global pandemic. Overpopulation, inequity, peak oil, and disturbed natural environment have converged with the problem of Ebola, to set up the conditions for a pandemic. If we add a slow response from complacent, frozen bureaucracies to this toxic mix, then we can expect a global pandemic to occur. We have met the enemy, and he is us.

Healthcare professionals need to speak up about healthcare inequity and US readiness for pandemics. And I have a particular interest in this topic, since I am potentially most exposed as a nurse to acquiring Ebola through patients shedding the virus in body fluids, and women are at high risk as typical care givers in the home and hospital. I have studied handwashing in hospital settings, with insight as to the gaps. So I will continue to perseverate here, and add my nursing voice to the choir of concerned healthcare professionals. Continue reading Ebola as a game-changer?

A review of Barry’s “The Great Influenza”

By Mary Odum

BarryCoverThis week I finally read John M. Barry’s 2004 book, The Great Influenza: The story of the deadliest pandemic in history. Barry explains the lessons that we should have learned from the Great “Spanish” influenza pandemic of 1918. The book is well written, albeit with a lengthy introduction of the medical researchers and their personalities. If you don’t enjoy the history of Medicine or details of early virology research, you can skip that part. In his afterword, Barry states that a future pandemic is certain to occur, and we are in no way ready for it. Since my PhD is in Nursing-Health Policy, this is a topic that interests and worries me greatly, so I will expand on my earlier post as this threat has continued to expand and evolve. This post serves as book review and comparison of similarities and differences between the Great Influenza pandemic and the current looming threat of another pandemic, Ebola (EBOV). Continue reading A review of Barry’s “The Great Influenza”

Stop growing or meet the four horsemen?

By Mary Odum

I took some time off from writing this summer, as I was busy getting unmarried and moving back to my original home, Florida. Don’t ever change your name—it’s a real hassle to change it back, from Logan to Odum. The divorce was quite amicable, after almost 40 years together, and Alaska provides few obstacles to the process. The house in Alaska sold quickly, to friends, so here I am, literally a hot mess, in north-central Florida, trying to re-acclimate to 92 degrees in the shade with 95% humidity. Instead of wolverines and bears traipsing through the yard, it is raccoons and possums. Instead of goshawks eating the chickens, I have fledgling cardinals at my feeder. And instead of glorious mountain tundra runs, I have quiet paddles along sacred springs and lakes. I have encountered enough old friends and acquaintances here that I am quickly regaining my sense of place in this sunny, hot, subtropical, watery paradise. Continue reading Stop growing or meet the four horsemen?