If a nurse wearing full protective gear contracted Ebola while treating Thomas Eric Duncan at Texas Health Presbyterian Hospital in Dallas, how safe are other hospitals and health workers in the United States?
Tonight on the PBS NewsHour Anchor Judy Woodruff will talk about the risks and precautions hospitals are taking with Dr. Howard Markel, a professor of medical history at the University of Michigan and author of When Germs Travel, and with Katy Roemer of National Nurses United.
While concerns about identifying, treating and containing Ebola in the U.S. are real, Markel told the NewsHour this afternoon the country is well-positioned to prevent larger outbreaks.
The following excerpt from that conversation has been edited for length and clarity. Watch the NewsHour tonight to hear more from Markel and Roemer.
How prepared are U.S. hospitals to identify and treat Ebola patients?
That’s a very broad question. We have four specialized infectious disease elite units. They’re incredibly well-prepared, have all the technology, they’ve done the drills. Across nation it really depends on the hospital itself. At a general hospital like the one in Dallas, I would really wonder how many times the health care workers have done the drills.
But remember, the patient with Ebola had multiple organ failure, kidney failure. He was on dialysis, that’s a very bloody procedure. He was also respirated and when you put the tube in an take it out, that puts lots of bodily fluids into the air. It’s very messy work. No one going to do it perfectly every time, but Ebola wants perfection or it gets you. The real issue is how prepared we’re going to be going forward. The Centers for Disease Control and Prevention has announced a great training plan, going over with doctors and nurses how to wear protective gear and make sure there are double and triple checks in place.
Just for some perspective — we had Thomas Eric Duncan who came from Africa, and now we have one infected health worker. Compare that to what’s happened in Sierra Leone or Liberia to date.
As someone who studies epidemics, there’s always lots of fear, scapegoating and blame. American tolerance for anything less than perfection has only shortened. The incredible thing to focus on is that so little has happened, so few cases have spread here. That doesn’t mean everything is perfect and preparedness doesn’t mean we’re going to be 100 percent prepared, but I have confidence in the CDC as we go along.
What does adequate training for healthcare workers treating Ebola look like? Is it practical for all workers to be trained on dealing with Ebola, or any other virulent infection?
It’s not very practical. Consider how rare it has been in the US up to a few days ago. When doctors and nurses are prepared — these are physical maneuvers and when they prepare they have do it a lot. CPR, we prepare everyday. We regularly have drills in hospitals to guard against garden variety infection. But things like this, we do them once a year, and I don’t have faith in being able to replicate something you only practice once a year perfectly every time. There are so many other things that need our daily attention — heart attacks, diabetes.
Another thing we aren’t hearing a lot about: the CDC budget been cut quite a bit through sequestration. Public health budgets in cities and states have been cut. Many say they don’t have enough resources to take care of tuberculosis patients or HIV patients. It’s hard to prepare for everything on the menu with limited dollars. So you try to prepare for the most common things first. And then sometimes you have egg on your face because when you hear hoof beats you think horses, not zebras. Would we want to devote millions of dollars going forward — when Ebola has been laid to rest for a while in a year, say — would we invest millions to train doctors and nurses to do this work going forward when there are so many other things they see more regularly. You have to do a risk benefit analysis based on how many dollars you have, which means you’re likely to be wrong a lot. Infectious diseases, they’re a lot smarter than we are, we’ve never conquered them. At best we’ve wrestled them to a draw. I hope we wrestle this one to a draw.
What about transferring any future Ebola patients to the elite infectious disease units you mentioned earlier? Is that a workable solution?
That was my first thought. These are very expensive and decked out units. But you have to have a very clear protocol in place with extremely well-trained people from healthcare workers to flight and ground crews because you don’t want to spread it to another place. Say you take this nurse to Nebraska and then you spread it disembarking from the plane?
What you may find going forward is that we’ll have more than four infectious disease high-tech units. They won’t be just for Ebola. We live in a world of emerging and reemerging infectious diseases, but there’s a question if you move people around there’s the danger of spreading it further. I know for a fact that’s being discussed in Atlanta and Washington right now. Another issue too — fear and panic seems to generate a logarithmic course particularly, I find, when the microbe in question is rare, deadly, extremely scary and has attacked relatively few people. Look at Anthrax and SARS, the response was huge. But look at tuberculosis, malaria, HIV/AIDS — those cart many more people off. Right now we need to fight Ebola. Going forward we need a comprehensive approach at the state, federal, global level of response. If we don’t have that we’ll get bitten again.
What are you worried about when it comes to another Ebola patient arriving at a general hospital in the U.S.?
In the olden days doctors and nurses used to die in line of fire, so to say, when treating infectious disease all the time. It’s only recently in the post-World War II era with antibiotics and improved vaccines and so on that has started to change. Duncan didn’t come with sign on his back saying: I have Ebola. The first case is particularly tough, the second and third cases are way easier. Imagine now, a patient saying they came from Africa vomiting and bleeding would get very different reception than they did a few weeks ago. It is of concern, because emergency rooms have traditionally been first lines of defense, it’s imperative that doctors and nurses acquaint themselves with these methods and have the isolation units. That said, you’ll have many more people vomiting because of garden variety infections or having had too much to drink the night before. But that’s the thing about epidemics, you’ll overcall sometimes, but that’s better than undercalling.
Are there things about the American healthcare system that you find reassuring in thinking about the response to Ebola in the U.S.?
The American system of medical care, the state of knowledge that doctors and nurses and others have, the technology hospitals have has never been better in recorded history. We can take heart in fact that even though Duncan died — some say 60 to 90 percent of people with Ebola will die — it was discerned. There was a nurse infected and that’s very concerning, not to play that down. We should expect a few other healthcare workers could contract Ebola. But look at Sierra Leone, Guinea and Liberia. We’re talking about one case, that’s remarkable. I have confidence that hospitals are doing a fine job. Will it be perfect? No. Medicine is never 100 percent. Ever. But the gotcha or blame circle distracts us from the real matters at hand — treating the ill, protecting health workers, making sure it doesn’t spread further — those are the prizes to focus on.