This month, the number of Ebola cases in west Africa has been creeping up. Liberia just reported its first new patient after a 28-day hiatus. It’s unclear how the affected woman, a 44-year-old food seller in the Caldwell community, northeast of Monrovia, contracted the disease. According to PBS NewsHour, she’s being treated in a Doctors Without Borders (MSF) facility.
Last week the WHO reported 150 new Ebola cases. That number’s up from the seven days prior, and part of a trend. Bloomberg News quoted Dr. David Nabarro, leader of the UN’s emergency Ebola mission, who expressed concern over stubborn pockets of the disease in Guinea and Sierra Leone. In recent days, several physicians working in Guinea have tested positive.
Days ago, a U.S. physician with Ebola was flown from Sierra Leone to the NIH, where he’s been in critical condition. Subsequently a group of at least 10 coworkers were evacuated and are under observation nearby designated U.S. medical centers. This is all costly, although that’s not my main concern.
Meanwhile the New England Journal of Medicine just published an article by Dr. Craig Spencer, the NYC physician who came down with the disease after working in Africa last fall and was treated here at Bellevue Hospital. As the doctor describes it, he was vilified for having gone around town during the 21 days after returning home.
I am glad, of course, that Dr. Spencer recovered from his illness. And I do not think he, nor most anyone who volunteers to work with Ebola patients, should be vilified. But I think that New York City lucked out that others didn’t catch the disease. As he wrote: “Ebola is frightening not just because of its high fatality rate, but also because of how little we know about it.”
Some journalists and others I know complained about the media circus surrounding Ebola. And while it may be true that concern was hyped, and that the epidemic in west Africa generated out-of-proportion fear in some communities, such as about airborne disease, it would be wrong to ignore the catastrophe Ebola has caused in west Africa and its potential to spread further.
This epidemic is nothing to take lightly. It’s not about the media. Nor is Ebola or Ebola news about one young doctor who somehow contracted the virus while working and living in a stricken region for weeks, received top-notch care and lived to tell about it.
Rather, the public might be reassured by straight information and caution. The CDC and WHO should not stop educating doctors, nurses and the public about hygiene and best practices, in hospitals and in affected communities, to reduce the odds of Ebola spreading.
Quarantines don’t work, we know from history. Besides, there’s a moral issue of forcibly isolating individuals against their will – I don’t agree with that tactic, in principle. But if you’re a physician or other provider at risk after exposure, you should voluntarily stay at home for the three-week incubation period and minimize contact with others.
It's common sense that someone who’s been exposed to Ebola shouldn’t sip on glasses or use forks that other people might use in a restaurant. The same goes for where he (or anyone who's worked with patients) places hands that may not be perfectly cleaned (and yes – we’re back to the bowling ball in Brooklyn, which should be a metaphor for something), where a teenager or someone’s grandfather might insert his fingers a half hour later, and then eat some chips or maybe just touch his lips by wiping his face after a strike, and then get sick.
Finally, I’m reminded of a patient I took care of when I was a medical resident. He was an older man with an unexplained cough and fever. I thought he should be placed on respiratory precautions, which meant that either he or we needed to wear masks when entering his private room, in case the diagnosis was tuberculosis. Because if any of us – the doctors and nurses on his team – caught that, we might spread it to other patients, besides get sick ourselves. The attending (senior) physician told me I worried too much. He cancelled my order. But it wasn’t for myself that I was concerned; I’d already been exposed and had prophylactic treatment. The patient, we found out later, did have tuberculosis.
The overriding point is about overconfidence, about not acknowledging what we don’t know, and what might be a cavalier attitude of some health care professionals about their possible exposure. I say this with the utmost respect and appreciation for the nurses, physicians and others who work, accepting risk to themselves, to aid those affected by Ebola and other illnesses.
