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Wednesday, October 01, 2014

Ebola is an infectious disease: American health care workers are front line experts

Although the etiology of the Ebola virus and longitudinal studies about the disease are ongoing, one aspect of treatment for the disease includes isolation of victims and strict infection control procedures to prevent the spread. America's health care workers are well trained to respond to an individual who presents with an infectious disease. Indeed, infection control procedures are included in all hospital personnel orientations, even among clerical staffs. Nevertheless, America's health care systems are not totally prepared to handle an epidemic of Ebola. One of the biggest problems isn't related to the causation of the disease, at all. Rather, the problem is ethical. Who will receive the most effective treatments?  Even worse, who will receive transport to a hospital for treatment?

America's health care workers are as much at risk for contracting Ebola as those who work with victims in developing countries in Africa. Most at risk are the emergency responders, who are likely the first ones called when a person becomes incapacitated by critical illness, like Ebola. Emergency providers are likely most at risk for being exposed to an Ebola outbreak, should one occur. 

Yet, there are a very limited number of ambulances available for transporting patients to a hospital or emergency treatment facility during an infectious disease outbreak, like Ebola.  

Transporting an Ebola patient puts the ambulance out of service until it's completely bathed in a chlorine disinfecting solution - twice. There are only a few transports any emergency medical transport will be able to accommodate, given the risk of Ebola exposure to the EMS responders. An additional risk of exposure includes the people cleaning the ambulance and equipment, following the transports.  

Therefore, when US public health officials are speaking confidently on national media about how Ebola will be managed, they're speaking about the disease process. They're not addressing the systems crises that will erupt as a result of the disease spreading. 

There's justifiable confidence in America's ability to respond to an isolated Ebola outbreak. Of course, the treatment of the victims will be expensive because of the intensity of the treatment of the isolated patient and the follow up "contact tracing" of those who are exposed.

It was just a matter of time before Ebola showed up in the USA. Indeed, it seems like our US health care system may have been victims of the "someplace else" delusion, like it would never happen to them. Now, it's here.  

The "someplace else" syndrome will be debunked. Health care systems will certainly pull out those pandemic policies from the years when H1N1 "bird flu" was supposed to cause a worldwide pandemic.

Meanwhile, in my opinion, the Ebola patient who traveled from Liberia to Texas before he exhibited symptoms of the illness, simply can't be an isolated incident. Not knowing who else may present as a result of the 21 day incubation time of the virus is, frankly, more dangerous than the disease itself.  

Health care workers can isolate, and treat the Ebola patient, and clean the transport and treatment equipment. 

What we can't do is predict who might be carrying the virus and where they might be located.  Therefore, the health care community isn't prepared to respond to an Ebola outbreak of more than a few people, unless a great deal of money is made available to pay for the training for a response to the disease. 

As with all infectious diseases, the most important response is prevention.  

Hand washing is the first line of defense for all infectious  diseases and more important than ever to help prevent Ebola.

America's health care providers are experts at handling infectious diseases and practicing infection control procedures. Nevertheless, the care givers and first responders are not systems analysts. 

In my opinion, our our US health care and emergency responder "systems" are not prepared to respond to an infectious Ebola outbreak.

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