So far – and admittedly, it’s very early – the pattern of transmission of Ebola in the United States has roughly matched the pattern of transmission in Spain.
These are the only two Western countries where transmission has occurred, and both cases happened to staff in hospitals under conditions that were supposedly in accord with recommended ebola-treatment protocol. In each case, authorities also have almost immediately assumed there was a breach, and that this is what accounts for the transmission.
In Spain, a nurse’s assistant who caught the disease had treated a Spanish priest who’d been transferred to the hospital from Africa in the later stages of the illness, with authorities knowing full well from the start that he was an ebola patient. She had contact with him very briefly towards the end of his life, and then helped clean up his room after death. She is reported to have perhaps breached protocol in the removal of her gloves, by touching her face.
The Dallas transmission is also being blamed by authorities 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 previously assumed that in all cases in which health care workers have contacted ebola from patients, the workers have breached protocol without realizing it, especially in Africa where conditions include heat and overwork, and sometimes poorly-trained personnel. But it has been a puzzlement that some of those who were infected in Africa have been the top doctors working on the disease; wouldn’t they, of all people, be expected to know how to be extra-careful?
There have been only a few ebola cases brought to the West for treatment, and only one (Duncan) who came here after exposure in Africa but first exhibited symmptoms here. And yet there have already been two transmissions to medical staff. That is a very high ratio, and is extremely troubling—and unacceptable.
It is also very troubling (although not very surprising) that officials don’t seem to be taking into consideration the fact that they may have to go back to the drawing board not only on training of staff, but on the design of the protective gear as well.
And what are the chances of a ban in this country on commercial travel from East Africa? Perhaps it would not prevent all ebola cases from arriving on our shores, but at least it could give us more time to prepare, since we clearly were not ready to deal with ebola. Unfortunately, the chances of a ban appear to be very small.
[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]
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