A couple months ago I wrote a piece about public concern with bringing an Ebola infected U.S. citizen back home for treatment. At the time I thought the hysteria surrounding this maneuver was way out of proportion to the potential risk of spreading the disease inside our borders. Given events over the past few days I may be rethinking that position.
This week’s revealing of the first ever transmission of the virus to another person on US soil is a game changer. While the method of transmission is not yet known, and the infected health care worker is reportedly in stable condition, the following two questions must be quickly answered to maintain the CDC’s and national health care system’s credibility;
How did the nurse contract the virus? I assume high level infectious disease personal protective equipment (PPE) protocols were in place and followed. But, I also know that the donning and doffing of this clothing and equipment is a cumbersome and often tedious process, introducing opportunities for inadvertent contamination. Employees often make mistakes or take shortcuts in an effort to speed up the process. Standard fire service hazardous materials response protocols are based on a team approach in ensuring potentially contaminated rescue workers are effectively decontaminated after working in the hazard zone. Even in the private industrial sector confined space operations someone is required to monitor employees working inside the space, and carefully watch the donning and doffing process to make sure the workers are safe and the hazardous material and equipment does not expose the worker or spread outside the hazard (“red”) zone. Is this approach standard protocol for hospitals as well, and in place during the time the nurse was working with the infected patient? Nope. As of this morning, the CDC guidance for health care workers states; “Consider posting personnel at the patient’s door to ensure appropriate and consistent use of PPE by all persons entering the patient room.”
If not already being contemplated, the CDC should mandate infectious disease protocols requiring a team approach and safety watch whenever a caregiver is required to enter the room and treat the infected patient.
Are my local hospitals and other medical providers prepared to handle an Ebola patient without risk of spreading the virus? This question is actually more about credibility than anything else. The CDC had previously been doing a great job at sending out information about the relative difficulty in transmission as compared to other viruses, and that standard infectious disease precautions used in medical settings are good enough to prevent exposure. The latest developments call into question the ability of ANY hospital in preventing transmission, at least until they identify how the nurse caught it. Citizens across the country are now likely questioning their medical provider’s ability to appropriately deal with a person who walks into their facility complaining of flu like symptoms after a trip overseas. And, the current CDC guidance doesn’t help:
“Seek medical care immediately if you develop fever. Tell your doctor about your recent travel and your symptoms before you go to the office or emergency room complaining of flu like symptoms after visiting Africa.”
How does one “seek medical care immediately” today? Yep, 911. How prepared are your local first responders in dealing with this potential? Also, when was the last time you were able to talk immediately with your personal doctor (assuming you even have one)? While the ability of the Ebola virus to spread is proving to be just as the CDC and WHO anticipated, the viral spreading of fear in the US has now taken on a new dimension. Let’s hope these organizations act as aggressively in containing this fear virus as well. To do so is going to take an innovative approach in clearly, consistently and continually engaging an increasingly concerned public, and they are now way behind.