October 6, 2014
Despite the continuing fears of the public and against general medical opinion, U.S. officials continue to downplay the possibility of an Ebola outbreak occurring here.
The multiple medical errors in Dallas that resulted in a symptomatic, contagious Ebola patient being sent home from the emergency room are the norm, not an exception. To expect otherwise is unrealistic. Omissions, errors, failures in communication, judgmental lapses…that’s reality in any primary medical setting.
60% of nurses polled say we are unprepared. An overwhelming percentage of physicians polled by Sermo last week said we are unprepared to detect and contain Ebola.
I envision the following scenario: A Liberian (Loma, Kissi, etc.) who is incubating Ebola virus in his body goes to Robbins Field in Monrovia for a trip to the US (or France, or the U.K.). If remembering to do his job, an airport worker asks if our traveler had been caring for an Ebola victim. He says no. An inaccurate temperature reading is taken by a handheld thermometer waved in front of his forehead, and is declared “normal”. No surprise, as he took ibuprofen. He flies on cramped airplanes, and after two layovers arrives in Newark or JFK or Heathrow or Orly. He takes public transportation to “Little Liberia” on Staten Island, or to Philladelphia, or Paris, or London, where he then lives in crowded quarters with extended family or friends.
When our traveler gets nausea, vomiting, belly pain and diarrhea he goes to the nearest urgent care, walk-in clinic, drugstore or emergency room. Eventually he is briefly seen by a nurse or P.A. or medical student, maybe even by a physician. Being just one more in a long line of patients seen that day with identical symptoms he is reassured, maybe given a Rx for unnecessary antibiotics, told to keep hydrated, and to take some Tylenol or Motrin for fever and Imodium for diarrhea.
He goes back to his dwelling where he continues to spread virus. Eventually he makes it back to the hospital via ambulance.
The number of people he has already infected is staggering. The public health system and the hospital may be able to trace many of his contacts, but certainly not all. Public apologies are made downplaying the incident and pointing out how the reason for this mistake has been remedied.
And he is just one person. Remember those 395 Ebola cases in West Africa that were all traced back to just one traditional healer in Sokoma, Sierra Leone? Sure it’s a different culture, but the virus doesn’t know that.
The condition of Mr. Duncan, the Dallas patient, has been downgraded from serious to critical. Here is his timeline, as reported by the NY Times (data from USAID):
Today Reuters reported that there is a “high risk” of Ebola spreading to the U.K. and France by the end of October. WIth no changes made in current containment efforts, there’s a 75% chance the virus will hit France by Oct 24, and a 50% of it reaching Britain by then. If flight restrictions are implemented, the numbers fall to 25 and 15%.
A Spanish woman is the first person to contract Ebola outside of Africa. She was one of the many health professionals in Spain who cared for a priest and a missionary who became ill in Africa and were flown home for treatment. She became sick on September 30, but wasn’t hospitalized until October 1.
In an ironic twist, people in Sierra Leone are raging over the delay in picking up and disposing of corpses, whereas just last month villagers were attacking workers for attempting to collect and bury bodies. This speaks well for community education efforts, though not for public health responses.
In the meanwhile, the exponential growth of the disease continues in West Africa. The hardest hit areas continue to be the homes of the Loma, Gbandi, Belle, Mende, Kissi, Kpelle, Mano and Dan.