Ebola Protocols Require Revision

I’m sick of reading about Ebola.

By Kevin RR Williams

HEALTH During flu season, emergency rooms and doctors’ offices are seeing an increase in the number of patients with influenza symptoms—fever, muscle aches and malaise. A disproportionately smaller number of Ebola carriers may present the same symptoms with one key difference—they either recently traveled from West Africa or were in contact with someone who had the Ebola virus. The news media has capitalized on those few patients, causing international fear of anyone perspiring.

Blog: International Ebola Battle

In the seven weeks since this site addressed what was being done to prevent spread beyond West Africa, Ebola cases have popped up in several other areas and hundreds of people that may have been in contact with such patients are under observation. As much as we hate hearing about it, the seriousness warrants our understanding of the current crisis.

Problematic Protocols

Despite assurances from the C.D.C. director, Dr. Thomas R. Frieden that any hospital is equipped to handle cases of Ebola, we have seen egregious faux pas, prompting Dr. Frieden to promise a team of specialists on the site of any hospital within the country with a confirmed Ebola diagnosis. Some hospitals claim that maintaining proper isolation units would bankrupt them.

Spain, France, Germany, Norway, Britain and the United States have all had what might be termed “outbreaks”—not qualifying as a pandemic. In Spain and the United States, patients were not properly isolated and protective gear worn by healthcare workers appeared inadequate. In fact, following the illustrated instructions on the C.D.C. website at the time leaves some skin around the neck exposed. [Updated October 20, 2014.] Using chocolate sauce to simulate contamination, Dr. Sanjay Gupta demonstrates how it can spread even while wearing such protective gear. The poster diagrams should be corrected.

Ebola Protocols Require Revision

Real-World Scenarios Require Statistical Planning

John Villasenor, professor of public policy in the UCLA Luskin School of Public Affairs notes that the gloves, mask, and other gear used for infection control are undoubtedly very protective. But when used in the real world, as opposed to in the laboratory, they cannot possibly be completely protective.

    If you do something once that has a very low probability of a very negative consequence, your risks of harm are low. But if you repeat that activity many times, the laws of probability—or more specifically, a formula called the “binomial distribution”—will eventually catch up with you.

    For example, consider an activity that, each time you do it, has a 1 percent chance of exposing you to a highly dangerous chemical. If you do it once, you have a 1 percent chance of exposure. If you do it twice, your chances of at least one exposure are slightly under 2 percent. After 20 times, you have an 18 percent chance of at least one exposure, and after 69 times the exposure probability crosses above 50 percent. After 250 times, the odds of exposure are about 92 percent. And the exposure odds top 99 percent after about 460 times.

Each time someone suits up and disrobes, the slight chance of infection increases. In developing protocols to protect the health workers on the front lines in the fight against Ebola, statistical methods—and more broadly, the big data those methods can be so vital in analyzing—shouldn’t be an afterthought.

One patient in Dallas was treated by more than 70 health care workers around the clock—covering themselves with what might be compared to everything from duct tape to cheesecloth in an effort to patch up holes apparent within the C.D.C. literature protocols. All are being monitored; two have tested positive for Ebola.

Officials Are Reacting to Concerns

As of October 16, 2014, at least 17 cases have been treated in Europe and the United States. As of October 8, more than 400 health care workers in West Africa have been infected with Ebola during the current outbreak, and 233 died.

The W.H.O. reported on October 14 that the number of new Ebola cases, primarily in Liberia, could reach 10,000 per week by December. The C.D.C. published a report in September that outlined a best-case scenario of 11,000–27,000 cases through January 20, 2015. The worst-case situation in the same report estimates the total number of cases could reach 1.4 million in four months. The Ebola epidemic cannot be ignored.

It has been repeatedly trumpeted that the virus is not easy to spread—limited to contact with bodily fluids. This makes it sound like one would need to kiss or have sexual intercourse with an infected patient. However, a perspiring feverish patient might use a public restroom, touch armrests, counters, and door knobs. The virus can thereafter be transmitted to someone touching the same surfaces who then wipes his eyes, nose or mouth. In the face of misinformation and serious gaffs, Ron Klain has been named Ebola Czar in the United States.

A total of 50 Ebola kits that cover health care workers from head to toe are in place—25 at Ronald Reagan UCLA Medical Center, and 25 at UCLA Medical Center, Santa Monica. They have also isolated separate critical care areas to prevent exposure to other ER patients. As reassuring as this sounds, such limited supplies could quickly be depleted on one patient within a few of days. Do you know of a hospital in your area with the proper facilities for handling Ebola patients? Has your workplace implemented any recent precautions?

Tags: humanitarian aid, news update, nurses, sickness

References
  1. Ebola Facts: When Did Ebola Arrive and Spread at a Dallas Hospital? nytimes.com
  2. How Hospital Workers Are Supposed to Treat Ebola Safely. nytimes.com
  3. Spanish Ebola patient's condition worsens, doctor says. cnn.com
  4. UCLA faculty voice: Big data analysis shows health care professionals at risk treating Ebola. ucla.edu
  5. Ron Klain, Chief of Staff to 2 Vice Presidents, Is Named Ebola Czar. nytimes.com
  6. UCLA doctors prepared to treat Ebola, other infectious diseases if needed. ucla.edu