There’s an old saying, “talk is cheap”, and unfortunately our handling of the Ebola crisis here in the United States has been proving the saying correct. We have all been hearing of how there are protocols in place, and though mistakes were made with the index case, it seems to me that there are those in the healthcare arena who still refuse to take the Ebola crisis seriously. In particular, I’m addressing those with documented exposures who refused to comply with their mandatory quarantine.
First, let’s look at chief medical correspondent for NBC, Dr. Nancy Synderman. Though under quarantine, Dr. Synderman took it upon herself to be out and about last week and go to a restaurant with friends. The rationale? She wasn’t exhibiting signs or symptoms of Ebola, so there was no threat of transmission. Since then, she offered an apology. With all due respect to Dr. Synderman, it’s our duty as clinicians to lead by example and not adhere to the old adage, “do as I say, not as I do”. During these trying times, how can we expect lay-people to adhere to protocols it WE don’t.
That being said, we now have a second case of Ebola with Amber Vinson, due to the index case, who is being transported to Emory University Hospital here in Atlanta. What is even more troubling is that, here again, was an even more serious breach in protocol.
Apparently, our second case was part of an exposed group that was not supposed to travel, yet the patient DID travel up to Cleveland and, reportedly, had a low-grade fever 99.4 to be exact, on the return flight to Dallas-Fort Worth. Even though the patient was not exhibiting symptoms of Ebola on the flight, how would you like to have been the person sitting next to case #2 on the flight from Cleveland to first Atlanta, then on to Dallas? Of course, there are those who are saying that it is very unlikely that you can get Ebola on a plane; that basically there has to be an exchange of bodily fluids from the infected patient either through open skin, mucous membranes or the eyes.
However, let’s look at nurse #1, Nina Pham. The CDC claims there was a breach in protocol. She claims there wasn’t. What was nurse #2’s risk, besides caring for the index patient? So here’s the scary question. Are we absolutely sure that you can’t get Ebola from being in close proximity to an infected patient regardless of their symptoms? My opinion is that we Just Don’t Know because we don’t have the data. Unfortunately, we’re about to find out. One troubling comment is that nurse #2 only had a temperature of 99.4, a whole degree below the threshold 100.4. In 30 years as an MD, I can say that no 2 patients have the same fever response 2 the same illness.
Additionally, there are Ebola experts that agree with my opinion. Last week Dr. C.J. Peters, who is at the University of Texas in Galveston, has done extensive work with Ebola and was interviewed by the LA Times last week in the article, “Some Ebola experts worry virus spreads more easily than assumed”. He believes that the spread of Ebola in tight quarters cannot be ruled out. In the same article, Dr. Philip Russell of the US Army Medical Research and Development Command believes that there are too many unknowns at this time.
Unfortunately, in both these cases of Dr. Synderman and nurse Vinson, there was too much hypothetical thinking applied, and not enough common sense. Selfishness and politics is not the way to fight this virus. Right now we are being reactive and not proactive. If we are to win this fight, we need to go on the offensive by bringing in experts like Peters and Russell who are more dogmatic and less political. Unfortunately, this crisis is evolving very quickly, so you can expect frequent posts.
