…who treated Thomas Eric Duncan.
I was wondering when the first US transmission would occur. I was hoping against hope it would not occur, but thinking that transmission was almost inevitable.
It is of interest that the first person to exhibit symptoms from US transmission is a health care worker who treated Duncan rather than a family member or friend who encountered him prior to his admission to the hospital. Of course, that doesn’t mean the latter group is out of the woods, not by a long shot. But it does suggest, if this pattern holds, that caring for an ebola patient in the later stages of the illness, even with protective gear, may be more dangerous than being around such a patient in the earlier stages—even though the delay in Duncan’s diagnosis meant that his family was around him, unprotected, as his symptoms become quite bad.
But the pattern of transmission here matches the pattern of transmission in Spain, which is that it occurred in the hospital under conditions that were supposedly in accord with recommended ebola-treatment protocol. And in each case, authorities have assumed there was a breach, and that this is what accounts for the transmission.
You may recall that the Spanish nurse’s assistant who got the disease had treated the Spanish priest (who’d been transferred to the hospital in the later stages of the illness, with authorities knowing full well what he had and employing the supposedly proper techniques to prevent transmission) very briefly, towards the end of his life, and then helped clean up his room after death. She is supposed to have breached protocol in the removal of her gloves, by touching her face. In the case of the Dallas transmission, it is also being blamed on a breach, this time an assumed one:
…[Dr. Daniel Varga,] a top federal health official said the health care worker’s Ebola diagnosis shows there was a clear breach of safety protocol and all those who treated Thomas Eric Duncan are now considered to be potentially exposed.
In addition [emphasis mine]:
…Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, on Sunday raised concerns about a possible breach of safety protocol and told CBS’ “Face the Nation” that among the things CDC will investigate is how the workers took off that gear ”” because removing it incorrectly can lead to a contamination.
“I think the fact that we don’t know of a breach in protocol is concerning, because clearly there was a breach in protocol,” Frieden said. “We have the ability to prevent the spread of Ebola by caring safely for patients … We’ll conduct a full investigation of what happens before health workers go in, what happens when they’re there, and what happens in the taking out, taking off their protective equipment because infections only occur when there’s a breach in protocol.”
Maybe yes. Maybe no. Maybe we just like to think that “infections only occur when there’s a breach in protocol,” because it’s even more frightening to consider that the current protocol may be inadequate. But one of the hallmarks of this particular outbreak has been that transmission to health care workers has been more frequent than in previous ones, and that sometimes the people who have been infected in this manner swear they’ve followed the rules. Officials have assumed the workers have breached protocol without realizing it, especially in Africa where conditions include heat and overwork, and sometimes poorly-trained personnel. But some of those who were infected there have been the top doctors working on the disease.
The fact that there have been two transmissions in the west, and both have involved health care workers who supposedly were in proper gear, is extremely troubling. But this entire thing is extremely troubling; we are in a heap of trouble. It is also very troubling (at least to me, although not very surprising) that officials don’t seem to take into consideration the fact that they may have to go back to the drawing board on protective gear.
And yet, what are the odds of seeing a West Africa travel ban here? I think they are very very low, unfortunately.
[NOTE: The article I linked to above is a model of how I believe reporters should be writing about Duncan and what he knew about his own exposure:
Duncan arrived in Dallas in late September, realizing a long-held ambition to join relatives. He came to attend the high-school graduation of his son, who was born in a refugee camp in Ivory Coast and was brought to the U.S. as a toddler when the boy’s mother successfully applied for resettlement.
The trip was the culmination of decades of effort, friends and family members said. But when Duncan arrived in Dallas, though he showed no symptoms, he had already been exposed to Ebola. His neighbors in Liberia believe Duncan become infected when he helped a pregnant neighbor who later died from it. It was unclear if he knew about her diagnosis before traveling.
Which of course doesn’t stop some people in the comments section there from blaming him.]
[ADDENDUM: One more thing—anyone who is involved in the treatment of this new case had better be extra careful. And each and every one of them deserves a medal, and combat pay. If you’re the praying sort, you might want to pray for them.
And for all of us.]