There’s a lot of panic going around about Ebola. A nurse who cared for the first person to bring Ebola to our shores via public transport has contracted the disease, and doubtless some of her co-workers will, also. There is fear-mongering, and a movement to cease allowing people who have been to West Africa to enter the U.S.
This article is about what we know, and what needs to be done. Future articles in this series will focus on the medical, historical and political aspects of Ebola.
First, and above all, avoid panic. If you want to worry about catching something, worry about CDiff, MRSA, Measles, Mumps, Whooping Cough and Polio. And as always, fingers, nails, fingers, fingers, fingers. Wash your hands. Then wash them again.
Most of the US was unprepared for a patient with Ebola. There are four facilities that are capable of taking care of this level of infectious disease: the Nebraska Biocontainment Patient Care Unit, in Omaha, the specialized unit at Emory University Hospital in Atlanta, the National Institutes of Health in Bethesda, Md., and St. Patrick Hospital in Missoula, Mont. Other hospitals have facilities to treat infectious and communicable diseases but Ebola is of the class Filoviridae, which is hardly ever seen in the Americas. (We’ll talk more about the virus itself in Ebola: Part 2 – Medicine.) Most of what is seen here are airborne, and thus reverse pressure suites and “standard” infection protocols are enough. Filoviridae are different, and require health care worker protection more akin to hazmat suits.
Further, despite warnings since February from Doctors Without Borders (MSF, known as Médecins Sans Frontières in most of the world) and other aid organizations with medical teams on the ground in Africa, we didn’t take the potential of patients arriving here seriously. No one did: not the government, nor the medical community. No systems were in place, they still aren’t. We’ll look at this in Ebola: Part 3 – Science and Politics.
There is a reason that the people who care for patients, most likely medical personnel, are most likely to contract the disease. With Filoviridae, the patient becomes more contagious as the disease progresses, in fact, the patient is most contagious when he/she passes away. There are certain protocols we know work to prevent transmission. The two most interesting come from Firestone (yes, the tire people) and their facility in Liberia, and a young nursing student who nursed 4 family members, and saved 3, without becoming infected herself. These two anecdotal incidents should give hope that it is possible to treat patients successfully, if and only if, the strictest of protocols are followed. None of this happened in Texas.
If you’re a medical professional, you give up the right to let fear dictate your actions: you depend on your training, and the best information available. I say this as someone who treated AIDS patients in the 1980’s, when there was still some question about whether the virus could be spread by tears. You’re a doctor, you’re a nurse, you chose that profession to save lives. I have great sympathy for those medical personnel who have become infected doing what they love, and that to which they are committed.
But the medical personnel in Texas were led astray by a number of factors. First, as the investigation will likely show, the CDC likely disseminated poor advice, or perhaps rather advice that wasn’t stringent enough. No buddy system. No space suits as exist at the four “really ready” facilities. Not enough training. Second, in a great shame to America, we have no Surgeon General, and we’ve been underfunding science for way to long (thank you, Republican knuckle-draggers, she said with dripping sarcasm.) Third, not enough people have been individually following the blog posts and missives that have been coming out of Africa since February, explaining what is working and what is not working. Finally, as a country, we rely on technology instead of base knowledge.
There are a lot of things that we could do over the next several days that would be of great help in this country. First, we could designate facilities in every major population center, especially ports of entry, that would be exclusive facilities for Ebola patients. They do not have to be hospitals, as Firestone has proven, just facilities. Better that they be hospitals, but facilities can come on line much more quickly. The staffing could include people from the four facilities who could adequately train additional workers. Second, we could set up 800 numbers for people who think they’ve been exposed. Then, teams could come to them instead of having them come into hospitals. Third, people arriving from West Africa could be quarantined in safe, secure environments. As we’ve learned from Nancy Snyderman and her crew, people cannot be trusted. Hell, she’s a doctor, she should have known better.
There are other actions we should take which will take more time. Nominate and confirm a Surgeon General. Release funds for vaccine and drug research without asking for an offset. (Personally, I’d use the money we’re wasting on the ISIS air raids, but that’s a different rant.) Start training people.