By Judy Stone
“Against stupidity, even the gods strive in vain.” — Fredirich Schiller
I’ve been glued to the Ebola news, riding the roller coaster of emotions. While very impressed with CDC’s director, Dr. Tom Frieden’s, initial press conference (10/2/14), I became infuriated at the subsequent statements from Lisa Monaco, Homeland Security Advisor, and the tragicomedy of the Dallas hospital’s farcical response, prompting this post.
Dr. Frieden was calm, reassuring and authoritative in handling this CDC press conference. He conveyed the critical messages well, “Remember, Ebola does not spread from someone who is not infectious. It does not spread from someone who doesn’t have fever and other symptoms. It’s only someone who is sick with Ebola who can spread the disease.” And he was candid: “It is certainly possible that someone who had contact with this individual, a family member or other individual could develop Ebola in the coming weeks. But there is no doubt in my mind that we will stop it here.” He emphasized basic, proven public health strategies of careful infection control, contact tracing, and isolation.
In contrast, although she acknowledged the possibility of a secondary case, Ms. Monaco appeared less credible as she stated, “I want to emphasize that the United States is prepared to deal with this crisis both at home and in the region. Every Ebola outbreak over the past 40 years has been stopped. We know how to do this and we will do it again.”
While I agree that we have the knowledge, experience, and resources to be able to control Ebola, most of the experts are academicians or practice in relatively well-heeled ivory towers. I have practiced Infectious Diseases and Infection Control for 30+ years, primarily in a number of community hospitals, and offer a different perspective here, based on these experiences.
Administrators vs. Practitioners
Increasingly, decision makers are administrators who are disconnected from the realities of patient care. The latest fad, for example is to design hospitals to look like hotels and be “inviting” to patients, although they are very dysfunctional for delivering patient care, especially problematic in ICUs.
Similarly, when “bioterrorism preparedness” first became the rage, our hospital and health department focused on high tech units and hazmat suits while ignoring basic hygiene. I went ballistic, given that there was no soap nor any paper towels in the public school bathrooms, something the county health commissioner said was “not within their purview.” Gotta have priorities, right?
It is not all that different now. One hospital I am familiar with has Powered Air Purifying respirators (PAPRs), purchased with bioterrorism preparedness grants, but neither stethoscopes nor other dedicated equipment for isolation rooms. So nurses and docs gown up to go in the room of a patient with a “superbug” but take their stethoscopes into the room and then on to other patients, perhaps remembering to wipe it down first.
The problems with controlling Ebola cases in the United States is not that we can’t care for people well, or with good infection control. We absolutely can. But the Dallas case abundantly illustrates some of the problems in caring for anyone with a communicable illness, whether a antibiotic resistant organism (aka “superbug) like carbapenem resistant enterobacter (CRE), measles or Ebola.
(More from Scientific American)