In the United States, where I live, and where there has been one imported case of Ebola and one transmission, one death and the other in stable condition so far, there is actually something far worse than Ebola Virus Disease (EVD). No, I’m not referring to “the new” enterovirus D-68 which has killed two children so far and has left many more severely ill. I’m not even referring to the upcoming influenza season, which if it is an average season, will take the lives of about 36,000 people of all ages by next summer in the US alone.
No, I’m referring to the fear-mongering and impending mass hysteria that has taken a hold of the American public now that Ebola is on American soil. Only in America is an n of 2 an epidemic. I don’t watch the news often, but I have inadvertently caught clips in patient rooms and more often than not, when the topic is Ebola, they have the picture of the virus up on the screen as if to say “if you see this squiggly blue hair-pin like object, run for your lives”.
Several of the commonly cited reasons for the spread of Ebola in the West African countries most affected center on a poorly educated population. Ha! Turns out this highly educated nation is not going to fare any better in this regard. I belong to an online physician community where the ignorance spewed is mind-blowing and the fear, very very sad. So, I guess I should not be surprised if “Joe the Plumber” also thinks that this is the Apocalypse…and that Obama and Obamacare are to blame.
But, I will say that if any part of society needs to be deathly worried about EVD it should be health care workers. After all, if we are to accept that Thomas Duncan became symptomatic with Ebola on September 24th, then looking at the calendar that was about 21 days ago. Thus, we are running out of time for his girlfriend, family members, friends, and their contacts and not to mention the various never-at-risk people who shared his plane ride to acquire the infection. Really! After 21 days, they would no longer need to be monitored or quarantined as were they to have been infected by him, they should be symptomatic by now. That really should tell the public something about the level of contact necessary to acquire Ebola from a symptomatic patient. It’s far easier to get measles from an infected person, but who cares about that?
That a nurse who took care of him extensively is now infected should not be too surprising in this regard, except for that pesky business of the report that she was wearing the CDC’s recommended personal protective equipment. And that’s why health care workers, including yours truly, need to be concerned. Rationally concerned I mean, not hysterically so. Another person with Ebola may walk into any hospital in the country. How many hospitals are ready? Judging from Texas Health Presbyterian Hospital in Dallas and the few hospitals I have privileges at, I will say very few.
Trending in the news lately is the story of the nurse with Ebola, the first case of transmission in the United States. The CDC statement that there was a breach in protocol has caused backlash in the form of nurses threatening to picket. Infection control experts have taken to Twitter to voice their concerns on the lack of preparedness of US hospitals in taking care of patients with Ebola. I’m sure many hospitals have put out reassurances through their communities that they are indeed ready. Mine has released statements to the press that they have spent a lot of time “making sure staff is comfortable with whatever could walk through the doors and that staff understand the
signs, symptoms, policies, rules, and protocols for treatment.” Ummm, not quite, but okay, if you say so.
I’m sad to report that even I, as an infectious disease specialist, albeit a junior one with no ties with the administrative powers, have not had provided to me access to personal protective equipment aside from the flimsy gowns and gloves we routinely use in patient care. I have not had access to any hands-on training in this regard. Sure I know what the CDC says, what the WHO says, but knowing the words is very different from being able to perform the actions. Contrary to the press release, I have received no notice from my hospital about what the protocol is. It’s a bit ironic that if a health care worker wants to go to West Africa to take care of Ebola patients, they have access to intensive preparations, but for those for whom Ebola may present on their doorsteps here in the US there is no such preparation. I guess I can take solace in the story of the woman who took care of several family members with Ebola in Liberia by using everyday items to create her own version of personal protective equipment. I guess I should stock up on a personal supply of plastic bags and duck tape. So suffice it to say that I am disturbed because I don’t believe the majority of hospitals are ready, and the mistakes in Dallas could occur anywhere else.
At the recently convened IDWeek, the annual meeting of infectious disease specialists, a summary was given in regards to the care provided to those two Americans brought back to the US and taken care of at an Atlanta hospital. Fluid losses were 5-10 liters each day. Imagine. Those eight glasses of water people say to drink every day? That’s under 2 liters. So now imagine, losing five times that each day and having to replenish that volume. With fluid losses come electrolyte disturbances and cardiac arrhythmia. Intensive care and constant vigilance were required to take care of the Ebola patients in Atlanta. I was surprised yet not really surprised to learn that medical couriers refused to transport Ebola specimens and that the hospital’s waste management service refused to handle any kind of waste from the Ebola patients. After all, in the news, it is being reported that the Louisiana Attorney General is doing everything possible to stop Thomas Duncan’s waste from coming to an incinerator there.
Speaking about self-centered people, Australia continues to refuse to “send health workers into harm’s way”. Meanwhile the African Development Bank is expressing concerns that Ebola donors are repackaging aid money and channeling it away from other areas of need and not providing more resources. The WHO is also condemning the pharmaceutical industry for being profit-driven and not investing in products for markets that cannot pay. On the other hand, this week a Canadian firm will begin human testing of an Ebola vaccine.
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