Ebola: No Easy Answers

image found here

So I've been sitting on my hands for the past few weeks, trying to restrain my urge to blog about the Ebola outbreak. But after the head of the CDC blamed a nurse for "protocol breach", I can't stand myself and as a result my blogging fingers have been unleashed.

You've been forewarned. .::Julia slaps on old, yellowed nursing cap::.

There's no ignoring the fact that the Ebola virus is the cause of a global public health crisis, especially after WHO Director-General Margaret Chan made this statement:

MANILA, Philippines (AP) — The World Health Organization called the Ebola outbreak "the most severe, acute health emergency seen in modern times" on Monday but also said that economic disruptions can be curbed if people are adequately informed to prevent irrational moves to dodge infection. Continue reading here. 

You can read more about the disease caused by the Ebola virus from the WHO here, and from the CDC here. In a nutshell this is a deadly disease which has an average fatality rate of 50%; this and other information about EVD was taken from a WHO fact sheet:

• Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
• The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
• The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa has involved major urban as well as rural areas.
• Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
• Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
• There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.

I admire the health care workers from all disciplines who are willing to literally put their lives on the line in an effort to care for these patients and to work to contain the transmission of the disease. While I have had no experience in caring for patients with a virus in the same category as Ebola, there have definitely been times when I -- like millions of other health care workers -- knowingly and while wearing personal protective equipment, have put myself in extremely close proximity to dangerous disease pathogens. And came away unscathed and uninfected, I might add.

Thank you, God.

Back in the days before the hepatitis B vaccine, hepatitis was a serious problem especially for those people on dialysis. My first job as a dialysis nurse required that I work in a unit that contained both a hepatitis B positive and negative section. As I was oriented to my new job, I looked with dismay at a collection of photographs in the med room which were of the yellow eyes of all of the nurses who had contracted the disease as a result of working the hep pos unit. One of the nurses shrugged her shoulders and commented, "It's an occupational hazard." I was fortunate that the vaccine against hepatitis B began to be widely distributed. I was one of the first in line when it was offered to our department, ensuring that my eyeballs wouldn't be turning yellow as a result of hepatitis.

I  remember an incident back in the '80s when I was asked to draw a blood sample for a patient that had HIV/AIDS. What I recall most about this blood draw was not donning the mask and gloves, or the actual venipuncture. I was most struck with the "what if's" as I held that tube of blood in my hand after it was collected. I spent a few seconds just staring at the sample and wondered how many HIV viruses were zipping around in there. What if I tripped and fell while holding the tube and it shattered sending contaminated blood everywhere? What if I had tried to re-cap my draw needle and stuck my finger with that germy piece of metal? I looked back at the red sharps disposal box which was in the process of being double-bagged before being sent to biohazard disposal and imagined the potential disastrous outcome should that contaminated needle be mishandled. I thought about the implications for not only me, but for John and our children, should I become an AIDS victim.

That's a lot to think about. But I placed those dialysis needles and drew blood from AIDS patients because......If not me, then who? Who would care for these people if everyone refused?

I can identify with the staff members all around the world who are suiting up in protective gear to face the Ebola virus head and hands on. Which leads me (finally) to the topic of this rant post:

Don't be blaming health care workers for the spread of this or any disease.

Honestly.

As one who has strapped on more yellow paper gowns than I can count, I can tell you that the protocol mentioned by CDC director Dr. Thomas Frieden is front and center in the minds of anyone taking care of Ebola patients. That protocol is the only thing that protects those caregivers from serious illness. Mistakes can be made, it's true. But it would be a highly unlikely event given the gravity of the situation. Which leaves a few more important questions which have been asked by large numbers of doctors and nurses:

• What exactly IS the protocol?  And how can this protocol, once defined, be effectively communicated to all staff members (read this)? How can staff technique for Ebola isolation be evaluated on an ongoing basis? The National Nurses United study reported, "Out of more than 1,900 nurses in 46 states and Washington D.C. who responded, 76 percent said their hospital still hadn't communicated to them an official policy on admitting potential patients with Ebola. And a whopping 85 percent said their hospital hadn't provided educational training sessions on Ebola in which nurses could interact and ask questions." Yikes. 
• We are told that any hospital in the US should be capable of safely treating an Ebola patient, BUT how can a small country hospital duplicate the whiz-bang isolation equipment and procedures that are found in highly specialized units capable of biosecurity levels 4 and 5?  
• And most importantly: Are we certain that all modes of transmission of the Ebola virus are known?

In a news conference today, Dr. Freiden  attempted to backtrack and clarify his comments. He apologized for implying any negative judgment on the nurse infected which was a very good thing; however he followed that statement by giving two conflicting messages: First, that we do not know exactly how this nurse was infected. And secondly, he is confident that current protocol correctly implemented will protect healthcare workers.

Wait. What? How could one possibly be confident of protocol that has yet to be determined without question to be completely effective?

Whew. Take a breath, Julia....

Sigh. See y'all tomorrow. I'm thinking I need to post some cute kitten videos......