Sunday, August 10, 2014

Ebola-Infected Healthcare Workers: What Does It Mean?

As I read comments on Ebola articles, it's apparent that many are still terrified that the virus responsible for this Ebola epidemic is worse somehow, more virulent or more easily transmitted because physicians and health care workers who are wearing protective gear are dying for God's sake! These people are highly trained and covered head to toe and they are getting infected!!! PANIC!

Actually, there's no need to panic.

For those who are genuinely worried about this I'd like to offer some information that will ease your mind.

Generally speaking, the health care workers treating Ebola patients in these countries have little resources or training to deal with Ebola, especially on this scale. Hospitals and clinics, like the one in Nigeria pictured above, don't have Swiffer wet jets, Clorox wipes or hand sanitizer dispensers mounted on every wall. If they do have full protective gear, it's extremely hot, adding to the exhaustion. These facilities have a lot of really sick people who are too weak to get up when they need to vomit or have a bout of severe diarrhea. It's a constant battle to treat patients and stay clean and it's hard to know where every infected droplet landed. Doctors and nurses are overworked, underpaid, exhausted and either still doing their best, or not showing up for work. I can't blame them but it adds that much more work to those who remain.

In addition to supplies and gear, training is critical. There are specific techniques you can use when cleaning spills, or handling infectious material that will significantly reduce the risk of infection if you know how to do it. Most of these health care workers weren't there specifically to fight Ebola, but they were there when the patients started coming in. Efforts at training are limited and when you are exhausted and overrun with patients, its easy to make a mistake or have an accident, and here, even those that seem minor can be deadly.

For comparison, here is what a facility designed to treat an Ebola patient looks like in a developed city (London)...

There really is no comparison.

Still, the health care workers in West Africa do what they can with the little they have. This Ebola is not some super Ebola that is airborne or can magically penetrate protective gear. There simply aren't enough trained people with the right resources to fight it. 

The nitty gritty details important for at-risk healthcare workers are in CDC Director Tom Frieden's recent blog post and for a truly remarkable account of what this is like in a field clinic, read emails from Dr. William Fischer II, a physician from UNC who has been on the front lines in Gueckedou, Guinea since May. It's a must-read for anyone who wants to understand why this virus is out of control over there.

The bottom line, and the reason this epidemic is out of control, is that these countries need help, a lot of help. Liberia's President, Ellen Johnson Sirleaf, even apologized for the lack it: "If we haven't done enough so far, I have come to apologize to you."

IF? Well, certainly they haven't done enough and the international community has taken far too long to rally. No one has done enough...except for the heroic doctors and nurses who have been, and are still, reaching out to help and comfort the sick, whether or not they have what they need. [EDIT 8/15/14 A new story in the Wall Street Journal illustrates this point all too poignantly]

Heroes indeed.



  1. And *this* is just one of the details that I try to educate people on. In an ideal world, we would have all the microchem, cavicide, bleach, etc. to perform proper decons.

    At least I can refer people to your very informative blog to help them see correct info.

    1. Patrick! Thank you so much for stopping by and for the kind comment! It means a lot coming from you!

  2. Do we have any idea what the mortality rate is without any supportive care in this outbreak? Is the r0 following patterns from previous outbreaks?

    1. Hi and thank you for stopping by and thanks for the question. There are a lot of different analyses floating around regarding the CFR for this epidemic, but until rigorous epidemiological analysis is done that includes data for only the cases with known outcomes, these reports are not reliable. The best information we have on this right now is from the new Science paper by Gire et al in which they report on data for 96 cases, 77 of which have known outcomes. Of those 77, 54 died and 23 survived. That gives CFR of 70%. You specifically asked about the rate without supportive care, but I would argue that many of those reported to be cared for in local hospitals aren't getting much in the way of what we would consider supportive care, there are simply not enough people to help and they lack the supplies to do so. A retrospective analysis will be critical here. We also don't have numbers for those who sought no help at all, and of those who died or who survived. Again this will be important to know and hopefully it will be information that we can eventually get. Logistics of that kind of data gathering in a place like W. Africa are incredibly cumbersome and prohibitive, so we'll have to wait and see.

      As for R0, it does seem to be similar so far...both the 1995 Kikwit outbreak and the 2000 Uganda outbreak had R0 of 2.7 and here it's a bit lower as determined by mathematical epidemiologist Christian Althaus. He reports that "The maximum likelihood estimates of the basic reproduction number are 1.51 (95% confidence interval [CI]: 1.50-1.52) for Guinea, 2.53 (95% CI: 2.41-2.67) for Sierra Leone and 1.59 (95% CI: 1.57-1.60) for Liberia.

    2. And here is a new paper on calculating R0 for this outbreak, out on 9/2/14