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Prepping for Ebola in Pennsylvania involves orchestra of departments
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?”
Watching Our Health Go Up in Smoke
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.
Outrage: Excalibur, the Pooch Exposed to Ebola, is Killed! Murderers!
“The pet dog of a Spanish Ebola victim was put down today over fears it could transmit the disease, prompting a wave of outrage from animal lovers who chanted `murderers` outside her home.
ebola
Madrid regional government health spokesman Javier Rodriguez confirmed tonight that Teresa Romero Ramos`s dog Excalibur had been put down, adding: “Unfortunately we had no other choice.`
The animal was sacrificed inside Mrs Romero Ramos`s home and its body driven out of the house in a white van just before 6.30pm local time to a nearby incinerator.”
Daily Mail
In spite of an online viral campaign to save the life of Excalibur, the pooch exposed to the Ebola virus, Spanish authorities murdered the friendly pooch today.
A Madrid government health spokesperson issued a statement explaining: We had no other choice. Bullcrap, they could have isolated and quarantined the pooch for the mandatory 21 days.
Excalibur`s body was taken to a nearby incinerator as if he was nothing more than an infected blanket, or medical waste.
The killing of Excalibur is an outrage to dog lovers all over the world, let`s hope it`s not a mortal blow to Teresa Romero Ramos, who is in a hospital battling for her life. She loved her pooch to death; let`s hope she will find the will to overcome the double tragedy of the death of her dog and Ebola.
More burners to incinerate invasive beetle headed to Hawaii
The Hawaii Department of Agriculture says we’re only in the beginning stages of the eradication and it could take years to wipe out.
“This is a very serious pest. It affects not only coconut palms, but all other palms. It will also affect bananas, pineapples, plumerias, so parts of what we know of Hawaii could disappear because of this beetle,” said Rob Curtiss, pest control branch manager for the Hawaii Department of Agriculture.
On Wednesday, KHON2 got a look at a new machine that’s being used to get rid of the beetles and the mess they leave behind.
It’s called an air curtain burner, a large incinerator that can burn any plant or green waste that may be infested with the beetle.
air curtain burner (1)
“These are trees that were cut down on base, about 120 of them,” Curtiss said. “We want to burn them before they’re able to get infested. It’s the best method we have of getting rid of the material.”
“It’s quicker. It’s more efficient,” said Lonnie Felsie, Naval Facilities Engineering Command. “It burns and then the residue that’s left is almost nothing. It’s five percent of whatever volume we put inside and so the ashes are almost nothing.”
One air burner costs around $80,000 and shipping it to Hawaii costs about $16,000. The one currently being used is owned by the U.S. Department of Agriculture.
The military also has four air burners on order, and the state Department of Agriculture plans to order one within the next couple of months.
“So we’ll have six of these machines on Oahu, destroying materials that could be infested by CRB,” Curtiss said.
The CRB has also been found at Barbers Point and Campbell Industrial Park, but traps have been placed all across Oahu.
State officials want to make sure it doesn’t spread any further.
“Just be aware of what this insect is and help us out by calling it in if you see something,” Curtiss said.
Hazardous waste plant awash in fines
If Clean Harbors Aragonite were a drunk driver, the Tooele County hazardous waste incinerator would have been taken off the road years ago.
Instead, the plant is an alleged serial violator of its state waste handling permit, racking up monetary penalties nearly every year for a decade — a total of more than $1 million.
And more are on the way.
Fines for violating environmental regulations are intended to deter future bad behavior, but activists are wondering whether the incinerator’s owners are getting the message.
Last month the Utah Division of Solid and Hazardous Waste reached a proposed agreement with Clean Harbors Aragonite LLC to resolve 21 violations documented in 2012. Under a deal that is subject to public comment through Oct. 17, the company will pay $71,155.
While those penalties were being negotiated, the division last April slapped Clean Harbors with a 32-count notice of violation — the company’s tenth since acquiring the plant in 2002 — based on inspections completed in 2013.
Officials with the plant’s corporate parent in Massachusetts downplayed the alleged violations as “administrative in nature.”
“There’s no significant risk to human health or the environment,” said Phillip Retallich, Clean Harbors’ senior vice president for compliance and regulatory affairs. “Our incinerator is state-of-the-art. It always achieves the rigorous compliance requirements for the Clean Air Act’s high-temperature emissions.”
Most of the allegations target reporting errors, failure to properly track and categorize waste, and other record-keeping violations.
“Having an inaccurate waste characterization could lead to mismanagement of the waste, such as placing flammables in places not designed for those hazards or placing incompatibles near each other, or it could result in excessive emissions,” Utah environmental regulators wrote in a report.
Retallich emphasized the firm has never admitted any allegations, but still pays the fines.
While regulators agree the public should not rush to conclude Clean Harbors is a public health menace, environmentalists are less charitable.
“It’s a dizzying array of violations,” said Brian Moench, president of Utah Physicians for a Healthy Environment. “It depicts a facility that isn’t nearly as safe as it should be. It paints a picture of significant hazards for the employees. It’s indicative of an attitude that is way too lax toward the material they are handling.”
Moench noted the records show the Aragonite incinerator processes dangerous materials like asbestos-bearing vermiculite and last year suffered 10 “bypasses,” where potentially carcinogenic smoke is released directly into the atmosphere.
“Those events can be extraordinary in terms of release of toxic emissions,” Moench said.
To be fair, the Aragonite plant’s alleged missteps have never included illegal discharges of pollution or covering up offenses, according to a 19-page compliance history compiled by the Utah Department of Environmental Quality.
A massive firm providing a variety of industrial services at locations across the nation, Clean Harbors is licensed in Utah to burn numerous hazardous materials, including infectious medical waste, pharmaceuticals and corrosive chemicals.
“Each requires different burn parameters, feed rates and so forth. They stage and batch it just right,” said Scott Anderson, director of DEQ’s hazardous waste division. “It’s a highly technical facility with one of the most prescriptive permits in the nation.”
