The Dallas, Texas hospital that treated the first Ebola victim in the United States had a full page apology printed in the major local newspapers on Sunday for its errors in diagnosis, treatment, and infection control. They apologized for failing to diagnose his Ebola on his first visit to the emergency room. They additionally apologized for “mistakes” made in the patient’s treatment. They are also responsible for the infections of two of their nurses during the patient’s stay, due to errors in infection control protocol that were ultimately the responsibility of the Centers for Disease Control.
The Ebola case has been a public relations disaster for the hospital, and there has been reduced patient traffic as well.
The National Institutes of Health has changed its procedures for protective clothing: “It became clear that we needed to modify that protocol where no part of the body is exposed…” sad Dr. Anthony Fauci, clinical director of the NIH’s National Institute of Allergy and Infectious Disease. Full-body suits, hoods, goggles, protective aprons, and rubber boots are used by the Doctors Without Borders teams, with a chlorine spray during de-gowning.
The reason for such intensive protection is that patients are constantly contaminating themselves with vomitus and diarrhea, and close contact is frequently required. In this outfit, a person can work only two hours before succumbing to heat exhaustion. In conditions of heat and stress, mistakes are frequent; workers are assigned to monitor one another for breaches in protocol.
These are the monstrous conditions under which a patient suffers from Ebola, with a fifty-fifty chance of succumbing to the disease.
A nurse has publicly come forward about the conditions at the emergency room where the first Ebola virus patient was treated. She described the “gown and glove” procedures and said that she had voiced her concerns to her supervisor at the time. She said she was told to just put tape over any exposed skin.
This is an important issue because unlike other, better behaved, infections, Ebola frequently causes copious discharges of vomitus, feces, and blood. Just cleaning up after an Ebola patient will strain the resources of the average American hospital.
It is clear that the two American nurses who are infected with Ebola were victims of poor infection control practices at the hospital where they work. This is especially obvious after observing the videos provided by the New York Times that show the gowning and un-gowning procedures that are recommended by Doctors Without Borders.
This same situation is also going on in Spain, where some of the nurses who treated a priest who returned from West Africa and died in a Spanish isolation ward showed symptoms and caused widespread anxiety.
Meanwhile, Senegal has quarantined itself and been declared Ebola free; Nigeria is nearly so. The three countries worst affected are Liberia, Guinea, and Sierra Leone. So far, the number of cases has doubled every month.
Sierra Leone is suffering from famine as a secondary result of the epidemic, and the World Food Program has been distributing food.
The World Health Organization, which is nominally responsible for coordinating international responses to contagious diseases, has criticized itself in an internal document for failing to respond so far, saying “Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall.”
We hope that the chief epidemiologists at WHO get a second wind and respond more aggressively. Otherwise, things will eventually come to resemble a Steven King novel.
CDC guidelines for health care workers in how to dress when treating an Ebola patient turn out to have been too lax, and were suddenly changed on Tuesday. The new guidelines involve a hood to protect the neck area, two pairs of gloves, and rubber boots as well as a rubber apron. In addition, dressing and undressing is to be individually watched by a supervisor, who ensures proper procedures are followed. These precautions may be adequate for workers.
They do not, however, include spraying with bleach or chlorine during removal of protective gear, which is done by Doctors Without Borders in West Africa. Respirators are also not recommended as they do not improve safety and cause claustrophobic reactions.
Additional information that has leaked into the New York Times: the Ebola patient who was admitted in Dallas after flying from Liberia had diarrhea on presentation on September 28. This condition made transmission of the virus all the more likely, especially if the health workers did not have dedicated shoe protection, which apparently was the case initially.
Just how infectious is Ebola? Apparently, only modestly so. It is not contagious, that is, it is not transmitted through airborne means. Body fluids and excreta are highly infectious, as is the skin of a deceased patient (noted in the preparation of corpses for burial, which involved extensive contact.) The main fear of Ebola relates to its high mortality rate (50 to 70 percent) and its florid signs (vomiting and diarrhea, frequently bloody, and blood seeping from orifices) after an incubation period of a week to three weeks, rather than its being easily transmissible.
We will soon (in the next three weeks) find out just how easily Ebola can be transmitted, because of the third Dallas patient’s airplane flight with a low grade fever, the night before she became really ill. Based on the information we have received about the poor infection-control procedures followed at the Dallas hospital where the first patient was treated, we can guess that the virus was transmitted through diarrhea contaminating the worker’s shoes. Thus, the other airplane passengers are unlikely to become ill (we think.)
Today we feel less concern about Ebola virus infectiousness. We could easily be wrong, and only time will tell.