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The ash of belongings of Thomas Eric Duncan, the man who died from the Ebola virus in Texas, may not be headed for a hazardous waste landfill in Carlyss after all.
Chemical Waste Management on Monday said it has “no current plans” to accept incinerator ash from Veolia Environmental in Port Arthur, Texas. Veolia incinerated some of the decontaminated belongings from Thomas Eric Duncan’s apartment located in Dallas.
“After additional review, Chemical Waste Management, has notified the Veolia Environmental that it has no current plans to accept ash,” the company said in a news release. “While (our) facility is permitted by the state and federal government to accept waste of this type, and while accepting this waste poses no threat to the environment or human health, we do not want to make an already complicated situation, more complicated.”
The items incinerated included linen, bedding, and carpet were taken from the apartment where Duncan became ill.
On Sunday, Chemical Waste Management confirmed that it would received the ash and state Attorney General Buddy Caldwell said he would file a temporary restraining order to block the move.
No world yet on what will be done with the ash now.
Medical experts need to rethink how highly infectious diseases are handled in the United States, a U.S. health official said on Monday, after a Dallas nurse contracted Ebola despite wearing protective gear while caring for a dying Liberian patient.
As an outbreak of the deadly virus spread beyond West Africa, hospitals and nursing associations across the United States were taking a closer look at how prepared they were to handle such infections.
“We have to rethink the way we address Ebola infection control. Even a single infection is unacceptable,” Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, told reporters. “The care of Ebola is hard. We’re working to make it safer and easier.”
Frieden said health authorities are still investigating how the nurse became infected while caring for Thomas Eric Duncan in an isolation ward at Texas Health Presbyterian Hospital.
Duncan died last week and the nurse is the first person to contract the virus on U.S. soil, taking concerns about containing its spread to new heights.
The infected nurse is Nina Pham, 26, according to a Sunday school teacher at the church where her family worships and through a public records check of her address. Attempts to reach her family were not immediately successful.
The family was in shock when it learned the young woman had contracted Ebola, said Tom Ha, a close friend of the Pham family who is also a Bible studies teacher at the Our Lady of Fatima Catholic Church in Fort Worth.
“The mother was crying, very upset,” he told Reuters.
The Dallas nurse is “clinically stable,” Frieden said, and the CDC is monitoring others involved in Duncan’s care in case they show symptoms of the virus.
Frieden also apologized for remarks on Sunday, when the nurse’s infection was first disclosed, that suggested she was responsible for a breach in protocols that exposed her to the virus. Some healthcare experts said the comments failed to address deep gaps in training hospital staff to deal with Ebola. [ID:nL2N0S8014]
“I’m sorry if that was the impression given,” Frieden said. He said the agency would take steps to increase the awareness of Ebola at the nation’s hospitals and training for staff.
The Texas Nurses Association defended Pham in a statement, saying it was wrong to assume the nurse was to blame.
“The facts are not known about how the nurse in Dallas was exposed,” the association stated. “It is incorrect to assume that the nurse failed to follow protocols.”
At his news conference, Frieden said some changes in procedures had already been put into effect, including having staff monitor those putting on and taking off protective gear, and retraining staff on how to do so safely.
He said other steps were being considered including new types of protective clothing and possibly spraying down staff with solutions that could kill the virus if someone were to become contaminated.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview with ABC that officials should consider sending Ebola patients only to a few “containment” hospitals.
President Barack Obama was briefed by Frieden and senior members of the administration about the second Dallas case and stressed that “lessons learned” from the CDC’s investigation should be shared with hospitals and healthcare workers across the country, the White House said.
Obama also spoke separately with U.N. Secretary General Ban Ki-Moon and with French President Francois Hollande about international efforts to contain the outbreak and to provide treatment centers in affected African nations.
A brief scare at Boston’s Logan International Airport caused emergency crews in protective gear to remove five passengers with flu-like symptoms from Emirates flight 237 from Dubai, but the CDC later said there was no Ebola threat.
EBOLA WASTE A CONCERN
Meanwhile, Louisiana’s top law enforcement official said he was granted a temporary restraining order to prevent the personal items of Duncan, who died on Wednesday, from being buried in a local landfill after being incinerated.
Louisiana Attorney General Buddy Caldwell said material collected from Duncan and the Dallas apartment where he was staying was taken to Port Arthur, Texas, on Friday to be incinerated. From there the incinerated material was to have gone to a hazardous waste landfill in Louisiana.
“There are too many unknowns at this point, and it is absurd to transport potentially hazardous Ebola waste across state lines,” Caldwell said in a statement after the restraining order was granted.
According to CDC guidelines, the Ebola virus does not survive on materials that have been incinerated.
The current Ebola outbreak is the worst on record and has killed more than 4,000 people, mostly in West Africa’s Liberia, Sierra Leone and Guinea. Duncan, a Liberian, was exposed to Ebola in his home country and developed the disease while visiting the United States.
Ebola, which can cause fever, vomiting and diarrhea, spreads through contact with bodily fluids such as blood or saliva.
The infection of the Dallas nurse is the second known to have occurred outside West Africa since the outbreak that began in March. It follows that of a nurse’s aide in Spain who helped treat a missionary from Sierra Leone, who died of the virus.
Officials said Pham’s pet dog, a 1-year-old King Charles Spaniel, would be kept safe while its owner was in the hospital. That contrasts with the dog of the health worker in Spain that was euthanized out of fear the animal could spread the disease, prompting protests from animal rights activists.
(Additional reporting by Julie Steenhuysen in Chicago, Jonathan Kaminsky in New Orleans, Marice Richter in Dallas and Roberta Rampton in Washington; Writing by Jon Herskovitz and Ken Wills; Editing by Michele Gershberg and Lisa Shumaker; Editing by Andrew Hay and Tom Brown)
BATON ROUGE, La. (WGNO) – A temporary restraining order has been granted blocking the disposal of incinerated waste from the Texas Ebola victim’s personal items at a Louisiana landfill.
The restraining order, signed by Judge Bob Downing Monday afternoon requires the transportation of the waste from a facility in Port Arthur, Texas to stop immediately.
According to a statement from Attorney General Buddy Caldwell’s office the burnt waste could amount to six truckloads. Potentially contaminated items from Thomas Eric Duncan‘s apartment were incinerated Friday in Texas.
The material was slated to be transported to the Lake Charles Chemical Waste Management Inc. facility. On Monday CWM told Veolia Environmental in Port Arthur, Texas, where the wasted is currently, that they will not be accepting the ashes because they do not “want to make an already complicated situation, more complicated.”
Adding that, “medical waste and hazardous waste incinerator ash, which is the residual that results from incineration, is not capable of transmitting infectious disease, including Ebola, and is safe for transport and disposal in a solid waste landfill without any impacts on human health or the environment.”
In a statement issued Friday, Veolia Environmental detailed how they decontaminated all Ebola waste. Read more here.
The Centers for Disease Control and Prevention has said properly burned Ebola materials pose no risk to humans.
Attorney General Buddy Caldwell said, “We certainly share sadness and compassion for those who have lost their lives and loved ones to this terrible virus, but the health and safety of our Louisiana citizens is our top priority.
“Even the CDC and our health care workers seem uncertain as to the effectiveness of purported protocols in dealing with Ebola. There are too many unknowns at this point, and it is absurd to transport potentially hazardous Ebola waste across state lines. We just can’t afford to take any risks when it comes to this deadly virus.”
The temporary restraining will remain in place until the court order to grant preliminary injunction can be heard on Oct. 22 before Judge Downing.
If you call 911 about a fever and vomiting in Allegheny County, don’t be surprised if the operator asks whether you recently traveled to West Africa.
Preparing for an Ebola case to be diagnosed in Pennsylvania is an orchestra of government departments, health care entities and private businesses, conducted by state and local public health departments, with guidance and manpower from the Centers for Disease Control and Prevention.
But dealing with the reality of an Ebola case can go very differently — missteps in Texas delayed treatment for Thomas E. Duncan, who died of the virulent disease last week.
Pennsylvania health officials are watching.
“I don’t think Texas changes on how we prepare for infectious disease outbreaks,” said Holli Senior, spokeswoman for the Pennsylvania Department of Health. “We will continue to watch, learn and adjust here in Pennsylvania as the situation evolves domestically and globally.”
The largest hospitals in Western Pennsylvania said they are prepared to treat patients with symptoms of the illness. Health giant UPMC trained special “SWAT” teams that will address Ebola cases. Allegheny County 911 operators could ask about travel before sending emergency responders to the houses of potential victims, county spokeswoman Amie Downs said.
Hazardous waste transporters who spoke with the Tribune-Review said that if a person falls ill at home, a private cleaning crew and transporter would be needed.
Contaminated materials likely would end up in an incinerator in Maryland because Pennsylvania has no incinerators for medical waste outside of hospitals, said David Henritz, owner of Bio-Haz Solutions in Lehighton in Carbon County.
It’s not clear what would happen if Maryland state officials or a company refused the medical waste.
Related: Stricter U.S. Ebola screenings to begin for travelers
“This is a complicated thing, and it’s not that anyone’s doing poor work. A lot of these players are organizations that haven’t worked together in the past,” said David Dausey, who leads preparedness drills as director of Mercyhurst University Institute of Public Health in Erie.
Many preparedness plans assume that someone would seek treatment at an urgent care clinic or emergency department.
“We’re making sure all the providers know what the checklists are. All those emergency rooms and hospitals should know what they should be doing,” said Dr. Karen Hacker, director of the Allegheny County Health Department.
Bill Smith, senior director of emergency preparedness at UPMC, said electronic medical records remind doctors and nurses to take precautions if a patient has symptoms and a travel history that suggest Ebola.
The patient would be isolated, though it could be in an exam room with a closed door and controlled access, Smith said.
“Our current thinking is that we don’t want to move anybody,” he said.
Hospitals within the Allegheny Health Network, including Allegheny General in the North Side and West Penn in Bloomfield, keep carts with special supplies ready to treat a patient with Ebola.
The carts contain items used in other functions in the hospital — face shields, goggles, extra gloves. Rather than paper gowns, there is a plastic, impermeable gown and plastic leggings. The goal is to make a liquid-proof barrier between patient and health care provider, said Dr. Robert Keenan, chief quality officer for the two hospitals.
Emergency preparedness involves steps fashioned to deal with severe acute respiratory syndrome, or SARS, avian flu or seasonal influenza, Keenan said.
Hacker said emergency providers should have appropriate safety gear if they arrive at a home with a possible Ebola case.
If someone goes to the hospital, his or her home may need to be cleaned and decontaminated. This requires a cleaning crew and the ability to transport hazardous biological waste on the highway.
“You’d pretty much have to destroy anything that person came in contact with,” said Bill Krulac, an emergency response expert with the hazardous waste management company McCutcheon Enterprises in Apollo.
Krulac said the company carries protective clothing and respirators and would remove anything in the house that came in contact with a patient’s bodily fluids. This could be sheets, a mattress and even clothes. Everything would be dunked in bleach and other cleaners and loaded onto a truck to go to an incinerator. The virus is heat-sensitive.
Staff at UPMC have been trained in intricacies such as the appropriate way to take off a hazmat suit, which starts with one ungloved hand slipping inside the suit at the shoulder and rolling it down to avoid touching the outside.
If someone dies, the body is double-wrapped in impermeable bags and taken to a crematorium, following federal guidelines, Keenan said. But the corpse of an Ebola patient is infectious, and it’s unclear what would happen if cremation companies refused.
Such weak links break an emergency response chain, said Dausey at Mercyhurst.
“If you come out and say, ‘Yeah, we were completely prepared,’ and something goes wrong, people think you lied,” he said. “If we’re prepared for the Ebola today, that’s great, but what about the Ebola of tomorrow?”
The medical waste incineration industry was given birth to in the late 1980s by the confluence of two high profile media circuses: one – the HIV hysteria – and two – multiple media accounts of bags of syringes, needles, plasma bags, IV tubing, bottles of pills and even body parts washing up on the shores of some of the most popular resort beaches on the East Coast stretching from Maine to Florida. In 1987, in Indianapolis, Indiana, 12 children were found playing with HIV-infected vials of blood that came from an unsecured dumpster used by a medical clinic.
In a classic case of the cure being worse than the disease, the knee-jerk response was a widespread call to burn hospital waste so that the various avenues of incompetence, corruption and profiteering that led to dirty needles washing up on exclusive beaches could be closed down through a back door. Little thought was applied to the consequences of incineration, until plumes of black clouds began billowing from hospital complexes. Neighbors complained, air pollution research showed that those emissions were indeed dangerous and the Environmental Protection Agency (EPA) became involved.
Eventually the number of incinerators contracted dramatically, but in part because “centralized” incinerators became an easy solution. Hospitals washed their hands of the matter by allowing their waste to be burned in someone else’s backyard.
As a result, Stericycle, headquartered in Lake Forest, Illinois, became the king of the medical waste incineration industry, operating six large incinerators throughout the country, including one of the largest medical incinerators west of the Mississippi in the heart of the most heavily populated part of Utah, the North Salt Lake subdivision of Foxboro, a few miles from my house. Stericycle now receives the medical waste of eight surrounding states there.
The relationship between Stericycle and Foxboro has always been tense. Efforts to shutter Stericycle were launched as long as 10 years ago by a handful of citizens concerned about the toxic brew that billows out of Stericycle’s short smokestack. It’s no surprise that burning medical waste, just like burning fossil fuels or just about anything else, creates a pollution potpourri of hazardous chemicals and gases, heavy metals and particulate matter.
Indeed, citizens’ concerns are validated by hundreds of studies showing multiple adverse health outcomes among people exposed, including higher rates of cancers like childhood leukemia and adverse pregnancy outcomes that I have written about in a previous essay.
The repercussions of the toxic incinerator emissions are made even more disturbing when adding the realization that the medical waste incineration industry was born on a false premise – that hospital pathogens must be incinerated. An EPA report dating back 25 years cites numerous studies showing hospital waste presents no more risk of spreading infection than household waste – which harbors virtually all the same viruses and bacteria. In fact, according to the Society for Hospital Epidemiology of America, “Household waste contains more microorganisms with pathogenic potential for humans on average than medical waste.” So why single out medical waste? Scalpels and needles can be shredded without incineration.
Many of the toxic chemicals and heavy metals in hospital waste are not destroyed by incineration. In fact, burning medical waste is the worst possible way to manage it.
While merely landfilling is a less than perfect solution, the possibility of contamination of usable groundwater is theoretical, not a certainty. Whereas with incineration, the emissions enter the air shed we all breathe from, guaranteeing public exposure, especially for those closest to the incinerator. The ash left over from incineration may be a smaller volume than the original waste, but it is much more toxic, and eventually has to be landfilled anyway.
Incineration does not prevent disease; it actually spreads disease. Incineration not only does not remove toxins; it actually creates new ones and concentrates, mobilizes and redistributes existing ones. Emissions from incinerators are probably the most toxic type of air pollution there is, contaminated with the deadliest compounds known to science, designated by the EPA as “HAPs” (hazardous air pollutants), which includes dioxins, benzene, PAHs (polycyclic aromatic hydrocarbons), furans, heavy metals and radioactive elements. Medical incinerators have even more deadly compounds not found in any other source, like residuals from chemotherapy drugs and even prions, the highly infective proteins that cause the 100 percent fatal human “Mad Cow” disease (which are much more common in human tissue than previously realized, and not reliably deactivated by incineration).
State health departments and environmental agencies are fond of claiming that toxicology assessments of the concentrations of many of these toxins are small enough to be written off as “safe.” The Utah State Health Department measured dioxin levels in the soil around Stericycle and declared the levels to be below any threshold of concern. If the devil is often in the details, in this case, the devil lies in the ignorance of the details.
Those toxicology assessments ignore the biologic complexity of the exposure. Many of these toxins are bioaccumulative, meaning they build up in the human body insidiously over time, and in even higher concentrations in certain critical organs and tissues.
Lipophilic (fat-like) toxins like dioxins highly concentrate in human breast milk. Nursing infants consume 10 to 20 times as much dioxin as the average adult. No toxicology assessments are ever based on the amount of dioxins in the human breast milk of people who live near incinerators, yet that undoubtedly is where dioxins wreak their greatest havoc on public health. Nor do those assessments consider the consequences of lipophilic toxins crossing the placenta that will primarily end up in the developing fetal brain because fat comprises about 60 percent of brain structural matter, and is the primary fat reservoir in the fetus.
Recently a new documentary was released that significantly raises the stakes in the long and sorry saga of this dying industry whose flagship corporate villain is Stericycle. The film features an undercover interview with an anonymous former Stericycle employee giving a credible, extraordinarily detailed account of fraudulent, illegal management practices far beyond what prompted the criminal investigation by state and federal law enforcement. The whistle-blower alleges shocking disregard for public and employee safety by Stericycle management – including directing employees to ignore the Geiger counter giving radioactive readings of the waste and to burn it anyway. Furthermore, he stated, the Geiger counter didn’t work much of the time.
While radioactivity is an inherent part of hospital waste, one of the few appropriate provisions in Stericycle’s permit is a prohibition of burning anything radioactive, and with good reason. No amount of radiation exposure is safe. Quoting from an article in the New England Journal of Medicine, “Mutagenic effects theoretically can result from a single molecular DNA alteration . . . every molecule of a carcinogen is presumed to pose a risk.”
In fact, the medical community is now much more cautious about the radioactive burden of many of our common diagnostic tools, like CAT scans, because of this growing recognition. Even low dose radiation exposure can damage chromosomes, alter gene expression and lead to cancer, brain diseases, immune disorders, birth defects and miscarriages – all of which North Salt Lake residents believe they have experienced in excess in their neighborhoods.
The ex-employee described management deliberately rigging the company scales and ignoring their permitted weight limit, a likely reason the state caught them exceeding their dioxin limit by 400 percent. Add to this the revelation that Erin Brockovich’s investigative team found dioxin concentrations in Foxboro homes to be inversely proportional to the distance from the incinerator. The home closest to Stericycle had 17 times the level of dioxins in its attic that would be considered average for an industrial area.
Incineration is widely recognized by international health organizations as an unnecessary, dangerous means of handling waste. Over 98 percent of medical incinerators have closed in the last 15 years – leaving a handful of communities like Foxboro to take most of the “hits for the team.” Utah’s governor, Gary Herbert, could close Stericycle on the basis of necessary public health protection, but he is loath to do so because he functions under the fog of the conservative mindset, that protection of business inherently has priority.
The whole medical incineration industry was a huge mistake right from the start, but Stericycle seems to have achieved immortality simply because someone is making money from it. The gnawing outrage of Stericycle is just a microcosm of the endemic failure of countless public policies held hostage to capitalism. Science, common sense, proportion, justice and human decency get thrown under the bus initially by fear and ignorance, and held there in perpetuity by ideology, exploitation and greed. We watch the same play over and over again with a different cast, be it gun control, the wealth gap, ISIS, our war addiction, GMO labeling, chemical and pesticide dysregulation, factory farming – and of course, the climate crisis. It makes me wonder whether we are not already living on the planet of the apes.