MORE HIGHLIGHTS FROM THE WHO SUMMIT

In September 2014 at a meeting of more than two hundred WHO leaders and Ebola experts, it was determined that the current Ebola epidemic is “the most severe acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long.”

It was determined that there is a pressing need to “identify the most promising candidate vaccines and experimental therapies and map out the next most urgent steps to take. The experts agreed to prioritize convalescent blood and plasma therapies for further investigation.” In reviewing the data, it was revealed that inroads had already been made in trying new therapies, aside from “supportive care,” and the summit convened with a determination to get various treatments tested and approved as quickly as possible, stating that the “WHO has been encouraged by the growth of interest in convalescent therapies as an already bad epidemic gets worse.”

The epidemic with world‑changing implications is spurring researchers throughout the globe to find a way to treat and eradicate this terrible disease.

NOW YOU KNOW…

Ebola is diagnosed through a series of special tests. Right now, the way it is treated is through “supportive care,” which means that the patient is supported by maintaining hydration and treating the symptoms as they appear. This is a strategy employed for many infectious diseases, even the common cold.

ZMapp is an experimental drug that has shown positive results in laboratory monkeys, and a few humans evacuated from the epidemic zone. While an effective Ebola vaccine may exist in the laboratory at the time of this writing, it is not yet widely available. Great strides are being made and it’s possible that one will become available to the general public soon.

There’s no certainty, however, so precautions still need to be taken. In the next part of the book, we’ll discuss how to ensure you are and stay safe.

PART 2: PROTECTING YOURSELF AND YOUR FAMILY

For all there is to know about Ebola, the most important thing you need to concern yourself with is how NOT to get it. In this section, we’ll look at measures you can take to keep yourself and your loved ones safe from this deadly disease.

5. Is Your Hospital Ready?

“ABOUT 70 HOSPITAL STAFFERS CARED FOR EBOLA PATIENT”

This headline from October 14, 2014, speaks specifically about Texas Health Presbyterian Hospital, the hospital in which Thomas Duncan received treatment for Ebola and died on October 6. One of the health‑care workers, twenty‑six‑year‑old Nina Pham, contracted Ebola, quickly followed by another, Amber Vinson. At the time of this writing, however, all the rest are still healthy.

There’s been a lot of panic surrounding the infection of Nina Pham and Amber Vinson by Mr. Duncan, which is similar to the case of Madrid assistant nurse Teresa Romero. All of these incidents have been blamed on human error. CDC director Dr. Tom Frieden was in the forefront of those who blamed the new cases on “breaches of protocol.”

A statement from the CDC went on that “…nurses, doctors, and other hospital employees wore face shields, double gowns, protective footwear, and even hazmat suits to avoid touching any of Duncan’s bodily fluids.” Therefore, they conclude that there had to have been a breach of protocol down the line.

“The first thing in caring for someone with Ebola is to do everything in your power to never become a victim,” confirms Dr. Aileen Marty, a World Health Organization doctor. It would seem that somewhere down the line, an error had been made. I doubt that we will ever get confirmation of a specific mistake made. However, it is clear that our medical personnel are not getting the training, education, and protective gear needed to safely care for Ebola patients.

The group National Nurses United conducted an ongoing survey of 1,900 nurses. In the survey, 76 percent of all nurses indicated that they were unaware of any policy at their hospital on dealing with deadly epidemics. Eighty‑five percent had no training sessions in which they could interact with an expert to ask questions. According to an Associated Press article on Mashable.com, gleaned from a statement by Deborah Burger of National Nurses United, Mr. Duncan:

was left in an open area of a Dallas emergency room for hours, and the nurses treating him worked for days without proper protective gear and faced constantly changing protocols… Nurses were forced to use medical tape to secure openings in their flimsy garments, worried that their necks and heads were exposed as they cared for a patient with explosive diarrhea and projectile vomiting.

This seems like an inexcusable, even criminal negligence on the part of the hospital with regards to the safety of their nursing staff. Each day a new misstep was uncovered, each one worse than the last.

In response to the outcry of “sloppy” conditions at Texas Presbyterian, spokesperson Wendell Watson offered that: “Patient and employee safety is our greatest priority and we take compliance very seriously. We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24/7 hotline and other mechanisms that allow for anonymous reporting.”

By the time the second health‑care worker who treated Duncan at Texas Presbyterian, Amber Vinson, was diagnosed, the general public at large seemed convinced that the hospital did not plan properly for Ebola patients. Not only that, but there was a deep sense of outrage when the news came out that nurse Vinson had been given the okay by the CDC to fly to Ohio after Mr. Duncan passed away, despite the fact that she had come down with a low‑grade fever.

TIP

76 percent of all nurses indicated that they were unaware of any policy at their hospital on dealing with deadly epidemics. Eighty‑five percent had no training sessions in which they could interact with an expert to ask questions.

How could the CDC and the hospital have given such an authorization? If the call were made randomly to any average citizen, the answer would have been a resounding “no.” It became clear that a clear national policy was deficient, if it existed at all. Indeed, the nation does not even have a Surgeon General at the time of this writing.

The human cost, in the lives of the two infected health workers, is immense. The financial cost, however, is almost as immense. The cost of treating Thomas Duncan during the time he was cared for at Texas Health Presbyterian Hospital has been calculated to be approximately $500,000 to one million dollars. That’s one patient. Presumably this includes the cost of emptying out the entire ICU to care for the one Ebola case, but I’m not sure. Imagine the cost of 100 Ebola cases? 1,000?

How would you know if your hospital was safe should an outbreak occur around you? Read on.

DO WE HAVE THE TECHNOLOGY?

We like to think that Ebola spreads only in the Third World, where technology is not as sophisticated as in developed countries. Places like West Africa, where doctors are not specially trained and conditions are primitive. You might imagine slapdash stretchers on dirt floors in “hospital rooms” that are really just canvas‑covered tents. Well, it’s not your imagination; it’s the hard reality of life in the Ebola zone.

We know that there are less than ideal conditions in African countries where Ebola’s spread has been rampant. The problems are huge there, but they also exist in the modern world. Texas Presbyterian Hospital and Madrid’s Carlos III Hospital are large centers that are well financed. Yet for all their resources, they were equally as inadequate to safely deal with Ebola patients as the broken‑down facilities in Liberia, Guinea, and Sierra Leone.

It’s troubling, even frightening, to consider that your local hospital may be unsafe, especially if it has all the advances known and available to modern medicine. Even if it sets records for cleanliness and efficiency, it may still not be ready for an Ebola outbreak.

Does your hospital have a plan of action in place to deal with a serious epidemic? Has it given adequate training to its staff, and will it provide the protective gear necessary for them to safely treat contagious patients? These are good questions to ask your local hospital’s administrator. If he or she answers “absolutely,” I still wouldn’t be convinced until they tell you how they reached that conclusion. If errors occurred at Texas Presbyterian, how is your local hospital any different?

I believe, in my heart, that the average hospital cannot handle the care of an Ebola or otherwise highly contagious patient. It’s not their main job; they’re used to medical problems like strokes, heart attacks, or injuries. There are very few hospitals that have the facilities and resources to ensure protection.

There are four high‑risk infectious disease centers in the United States in Maryland (NIH), Atlanta (CDC), Nebraska, and Montana. I urge hospitals throughout the country to transfer all Ebola patients immediately to one of these centers. They are better equipped for the job.

WILL IT HAPPEN AGAIN?

In a recent article, CNN.com offered seven reasons why a situation that occurred in the Dallas hospital where Thomas Duncan died would never happen again. Here’s the gist of what has been reported:

1. Duncan wasn’t hospitalized right away. This was a result of the failure in the chain of communication. Texas Presbyterian will think again before sending home any patient with a fever and a West African travel history. Hospitals all over the nation will likely be more on guard about doing the same. A higher index of suspicion will lead to fewer discharges from emergency rooms until more testing is done.

2. Duncan did not receive an experimental drug immediately. The difference between the care of Dr. Kent Brantley, Nancy Writebol, and Dr. Richard Sacra, and that of Thomas Duncan, is that because Brantley and Writebol were quickly diagnosed with Ebola, they were given the experimental ZMapp drug early in the course of the disease. Many attributed this to their successful recoveries (even though, honestly, we don’t know). Hopefully, a stockpile of ZMapp may become available in the future.

3. Duncan was given the wrong experimental drug. When he was finally diagnosed with Ebola, he was given a drug called brincidofovir, a drug designed to inhibit the ability of the Ebola virus to replicate itself. While brincidofovir is already in Phase 3 clinical trials, it’s not known whether it was not effective on Duncan because it simply didn’t work, or if it was administered too late to save him. Once trials are completed, it will be clearer whether brincidofovir is effective or not.

4. Duncan was not given a blood transfusion from an Ebola survivor . In addition to giving infected patients ZMapp, it is suggested that blood or plasma transfusions from Ebola survivors may help combat the disease in victims. It is not known why Duncan was not provided this option; though, at the time of this writing, reports confirm that Nina Pham has been given a donation of plasma from Dr. Kent Brantley. Perhaps going forward, other hospitals will follow suit.

5. Texas Presbyterian had no advance warning. Emory knew exactly what was coming to them when Dr. Brantley and Nancy Writebol were delivered there direct from being infected in Liberia. Thomas Duncan was, in effect, the first walk‑in. Yet, I disagree here. We were given warnings about Ebola. Its mere presence in an area easily reached by air travel should have been the warning. Our top health administrators failed to adequately plan ahead.

TIP

“Infections are a leading cause of deaths and complications for nursing home residents and, with the exception of tuberculosis, we found a significant increase in infection rates across the board.”

Average citizens don’t spend a great deal of time thinking about what they would do in an epidemic, and what the local health center would do to protect their health. They expect our appointed health officials to plan for them, and by doing so, ensure their safety.