More on Ebola

With the first – and probably not the last – documented case of Ebola in New York last week, the reaction of State and local governments was big news, and the preparations of the North Shore-LIJ Health System kicked into a higher gear.

New York City Mayor Bill DeBlasio, flanked by the President of the city’s Health and Hospital Corporation, Dr. Ram Raju, and the city Health Commissioner, Dr. Mary Travis Bassett, gave a news conference. I thought they struck just the right balance of information and reassurance, and grounded their responses in what is known about the disease. In discussing the movements of the patient, a physician who had been working in West Africa with Doctors without Borders, prior to his admission to Bellevue, they repeatedly stated that he had posed no threat to the general public. Indeed, they cited the case of the man who died of Ebola in Texas, who had spent days living with family members at a much more advanced stage of his illness, and did not transmit the disease to any of them. Of course, 2 nurses who later cared for him did, but he was far sicker by then (which means he had a much higher viral load, and was correspondingly more infectious), and we now know they likely had inadequate training and personal protective equipment.

The bottom line is that people without symptoms, or even early in their course, pose no measureable threat to those around them. Of course, you wouldn’t know that based on the grandstanding by a variety of politicians staking out more extreme positions in the name of public safety (or political toughness).

This is playing out most visibly in New Jersey, where the governor has imposed a quarantine for anyone returning from caring for Ebola patients in West Africa. I believe this is wrong-headed and counterproductive. Wrong-headed because it is not based on the known epidemiology of the disease. People, who are well, even if they harbor the Ebola virus and are destined to become sick, are not a threat to those around them. Counterproductive because it stokes fear by implying the disease is more communicable than it is, thereby interfering with fact-based public health pronouncements, and because it will make it even harder to recruit volunteers to care for patients with the disease in Africa.

It is also hard to see how this would play out for health care workers caring for Ebola patients here. If the “NJ rule” were followed, then the staff at Bellevue might be quarantined, making the provision of care more complicated and demanding than it already is.

Preparations at our Health System continue. All clinical personnel are being educated. Volunteers for an Ebola care team are stepping forward and are being trained. A dedicated communicable disease unit has been established. Protocols have been written, implemented and tested. Equipment has been stockpiled and distributed. Best of all – calm professionalism has prevailed. I think we are doing the right thing for our staff and our community.

What do you think?

5 thoughts on “More on Ebola

  1. I just don’t agree with you about quarantine. I’m thinking of the 2 year-old girl that died in Mali. I’m thinking of the nurse that traveled to Ohio from Dallas. Then I think of Nurse Pham, who is a credit to the nursing profession and is a model of what an American should be.

    We have learned that people often don’t asses themselves properly, and that people lie. It’s great that people will go to troubled areas and sacrifice to care for others. But this does not make them all wise- all knowing- and Nurse Kaci is acting like a spoiled brat.

    My doctor is from West Africa. I dated a French doctor that was teaching some classes at the university medical school. He came up from Nicaragua, taught here, went to France and then packed up for the Sudan. He retired, but I haven’t heard from for several months. I know that he would submit to quarantine, because he wouldn’t take the risk of infecting anybody in any country.

    1. What about the nurse who traveled to Ohio? She did not pass the disease to anyone, despite the media frenzy about it. Besides, restricting travel, which I agree seems reasonable (since someone could develop symptoms while away from home) is a lot less of a burden than unnecessarily quarantining someone.

      1. Not traveling and staying home is still a form of quarantine. I think that we should look at the Army for an example. During the flu season, we’re given instructions on how not to spread the flu. Wash our hands often, stay home—whatever.

        I live in a plague and Hanta virus state. Every year, we have at least one or more deaths from these. We don’t go around scared of catching these things. We do wear glove, face masks, and use bleach everywhere to prevent catching Hanta while cleaning a shed or under the hot water heater-the virus is in the urine and feces of white-footed deer mice. For the plagues, controlling the dogs and cats are the key. Flea medication for them, use a shovel to remove a dead prairie dog. If you run into bunch of dead rodents-contact the authorities. Then we call our health care system, and sort of stay away from other humans-and this is mostly a rural area.

        Also- we do not like to be around people that cough. Since neighbors and strangers here- even semi-illiterate people treat each other with consideration about the possible transfer of a deadly virus to another person and our families, why shouldn’t medical staff be considerate of the populace, especially until we figure out what’s going on? What would Semmelweis say? Perhaps that medical personnel still resist the practice of good medicine in preventing the transfer of infections?

        The CDC has been playing catch up—By the way– some Texans came to New Mexico and were contaminated by deer mice, and they came down with Hanta in Texas. This was before the doctors listened to the Navajo medicine men about deer mice bringing death. People cancelled trips to and through New Mexico. They had a choice, and they chose their own form of quarantine—Avoid possible contamination.

        When you have people with exposure to Ebola meandering around- flying-shopping, the people that are exposed don’t have a choice in avoiding possible Ebola carriers-and the people exposing them are selfish. Yes, a cough or a sneeze often carries particles of infected body fluids.

      2. One more point- you mentioned restricting travel– Kaci was traveling and needed to be restricted, so she’s suing— The nurse that went to Ohio traveled. The nation is lucky, but our health care shouldn’t depend so much on luck.

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