I know I keep yakking about CNN and Anderson Cooper's coverage.

I know I keep yakking about CNN and Anderson Cooper's coverage. It just ends up being the only time I tend to be in front of a TV, and when I try to find something mindlessly entertaining to watch, it's just mindless, so I end up watching CNN. Anyway ...

As you may know, I am highly critical of sciencey coverage and reporting in general, so the fact that I am impressed and feel it worth pointing out for praisin' and pettin' just shows how much they think like me how intelligent I am that I can recognize quality work when I see it. They are choosing well for their guest experts, by whom I am also impressed. The interviewers and the interviewees are, in general, maintaining appropriately calm, factual, considerate demeanors, neither dismissing nor denigrating the fears and concerns of the public (and some entertaining public officials). Thus far, as well, the mayor of Dallas seems to be well considered in his public statements, at least.

As an example, Sanjay Gupta did a demo of the CDC guidelines for putting on and taking off personal protective equipment (PPE). To demonstrate any possibility of accidental exposure, they used chocolate syrup (kudos). He's a surgeon, so not unfamiliar with gowning and gloving, and, having worked in hospitals, would have been trained in such for isolation patients. In addition, he went to West Africa and was trained with MSF (Doctors Without Borders) in their procedures for protective gear in order to enter ebola areas.

None of which precisely relates to the CDC guidelines specifically for PPE with highly infectious patients with ebola. So he demoed putting stuff on and taking it off per the CDC, and showed how it can be difficult to get the gear to cooperate, and how, particularly since there is exposed skin, it is possible for there to be unexpected exposures, even if you are being careful. (He got two little spots of syrup on his arm and neck.) What this showed is that you have to be very precisely trained, very pedantically careful about everything you do, and the gear has to perform exactly as expected. It's harder than people think, and it cannot be treated similarly to any other normally encountered patient isolation situation.

Experts are debating about what the procedures should or should not be, including what gear should be used. MSF uses gear that completely covers you up. You've seen it on TV or elsewhere. In addition, you step into bleach and they spray the suit down with it before you take it off. They have been dealing with ebola since the 70's and it reportedly is only with this outbreak that they have had any incident of one of their healthcare workers infected. (The Americans and majority of the Africans who have become infected were not specifically MSF staff.)

The one thing they do that people here are starting to implement is a buddy system. Someone watches you dress and undress with the PPE, because the extra eyes can sometimes prevent or at least identify an exposure risk. I think that's advisable.

Other ongoing debates relate to the fact that we only have four hospitals specifically set up to care for this level of pathogen: Omaha, Bethesda, Atlanta, and Missoula (I have no idea why Missoula). However, any major Level 1 hospital is probably equipped and staffed sufficiently to handle this. What I didn't think about, because I am spoiled in where I have trained and worked, is that that is not all the hospitals, because all hospitals don't need to be that. The hospital in Dallas, frex, is a community hospital that is not a Level 1 center. Not only would they not have been prepared to deal with something like this, the powers that be probably assumed they didn't need to be. Surprise.

We do not have a protocol in place of which I am aware that any potential ebola patient would be isolated and immediately transferred to a Level 1 facility, at the least, if not one of those four infectious disease (bioterror?) specialty hospitals. I think it is worth considering, since we are not overwhelmed with hundreds of patients. These institutions have facilities and staff trained, experienced, and designed to handle this stuff. It does matter. Probably most in those little ways that are hard to quantify. It may make a difference to the patients; it definitely could make a difference to the doctors and nurses at risk. Yes, the transport itself is a risk, but they can do it from another continent, so they should be able to manage it within the US.

Another thing they keep saying is that the hospitals don't have autoclaves. From what I can now gather, the non-level 1 hospitals may or may not outsource their biohazard waste, but even if they have an autoclave, it is not one of the great big ones. This is an issue when you are dealing with those rare things like this one that absolutely require everything that has ever been near the patient, or used to clean the room, or used to enter the room be autoclaved, ideally without ever leaving the building to be handled by yet more people, however carefully.

P.S. If it's been incinerated, and it's ashes, it's not infectious. Just so you know, officials in Louisiana (and elsewhere). This virus is viciously infective, but it's relatively ridiculously fragile.

I have other thoughts, but will post them another time. Still not panicking. This isn't smallpox. Thank fish and little gods.