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Ebola in New York

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News media is now reporting that a Doctor Without Borders, recently returned from ebola-ridden Guinea, has tested positive for the disease after reporting a high fever.

Ebola, which has been particularly harsh on healthcare workers, is a deadly viral disease that has taken 5,000 lives in West Africa during an epidemic that has devastated economies in 3 different countries.

The doctor, Craig Spencer, had not been under quarantine since returning from the ebola zone as it is not the policy of the United States to isolate people traveling from West Africa.  He had been out and about in New York City but had been self-monitoring for fever since his arrival.  Although he felt fatigue for the last 2-3 days, he immediately called Hazmat units when his temperature suddenly rose to 103 degrees Fahrenheit.

(Dr. Alton says:  Since this was written, the story has been corrected to say “100.3 degrees, not 103, which makes a lot more sense)

The government has called in specialists to evaluate and begin the process of treating Dr. Spencer for his illness. Hospitalization is a large factor in the likelihood of survival of ebola patients, and only Liberian national Thomas Eric Duncan has succumbed to the disease in the United States. Despite this fact, the grim news of another ebola case underscores the vulnerability of the nation to lax standards in controlling travel from West Africa.

The rapid response of New York-Presbyterian hospital to isolate Dr. Spencer will likely prevent a community-wide outbreak, but the issue of the cost of dealing reactively, instead of proactively, with possible cases remains. In Dallas, one ebola case shut down an entire intensive care unit and caused 2 nurses to become infected.  In New York, the costs will also be high, although we can hope that the hard lessons learned in Texas will help protect those that will care for Dr. Spencer.

With each new imported ebola case, there will be more and more of an outcry against the inadequate measures taken to protect the American public. The continued free travel of people from the epidemic area will continue to produce challenges for the United States.  There are, at present, only 19 beds total in 4 containment units adequately equipped to deal with the virus. More cases (and it would be naïve to think there won’t be more) could tax our ability to keep our citizens and health care workers safe.

It seems clear to me that certain actions need to be taken to maintain public safety:

1) All ebola cases to be immediately transferred upon diagnosis to the few beds equipped to deal with them.

2) A national policy that is mandatory for all hospitals to increase their ability to deal with infectious disease outbreaks, including advanced training for health workers as well as a greater investment in high-level personal protection gear.  In addition, no health worker is to remove personal protection gear without a team to monitor for accidental exposures.

3) Quarantine of all travelers from West Africa for a period of more than 21 days. (Imagine the cost involved in achieving this goal) It is clear that self-quarantine is simply not effective.

4) Strict tracing of all contacts of confirmed ebola cases, with regular face-to-face visits to screen for symptoms for more than 21 days.

5) Serious consideration of a travel ban from West Africa, as has been implemented by more than 20 countries. (#4 and #5 on this list is the reason that Nigeria is now successfully ebola-free)

6) Increased aid to West African countries affected by the ebola virus in an effort to contain the virus.

We should be aware that the current strain of ebola virus in West Africa seems to have high levels of “viral load”, that is, the quantity of virus present in those infected.  As such, it is reasonable to believe that the disease may  become a continuing epidemic in West Africa, and a regular visitor to the United States.

We expect our government to ensure the health and safety of the general public, yet we have no Surgeon General nor any signs of life from an “ebola czar” or Secretary of Health and Human Services.  If we are to place our trust in our top health officials, they must remove political considerations from their decision-making process and act now to fulfill their obligations to their fellow Americans.

Joe Alton, M.D.

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