Over the last week, the number of Ebola-based news reports, whistleblower accounts and commentaries in traditional and social media has grown exponentially. The crisis has gone from a sideline story involving three West African countries to the foremost topic of discussion in North America. Today, Ebola is on the mindset of almost every Canadian.
While this spotlight has led to movements by a number of nations, including Canada, to increase involvement in containing the epidemic, other notable pieces of information have been gained. Most of them have not been covered in the media but they all offer perspective on human nature when faced with an unknown threat as well as the actual risk associated with it.
The most prevalent revelation is the ease by which the public can lose confidence in their leadership. When Thomas Eric Duncan arrived at Texas Health Presbyterian Hospital Dallas and was put into isolation, the overall public view was one of concern but not panic. After all, most public health officials had suggested the virus could come to North America through travel.
Yet, as his condition worsened and the details regarding lapses in proper treatment came to light, the public's opinion of the CDC soured. By the time he passed, many of the gaps between proper treatment and the actual work performed were known. As a result, many were left wondering whether America -- and by extrapolation, Canada -- was even remotely prepared.
This was only the beginning. With the news of two confirmed and another suspected case of infected health care workers, the seemingly unbreakable national barrier of protection assured to the American people by the government became cracked. When details revealed one of the nurses had traveled, a breach of a 21 day isolation and monitoring protocol, the walls crumbled. Not surprisingly, local authorities took matters into their own hands, closing schools, cancelling flights and sending out the alarm to anyone who might have come into even remote contact with the nurse.
While the production of panic may be the lead story; other details have emerged suggesting there may be a silver lining to Ebola in America. By having the virus on American soil, several factors dealing with its spread, treatment and management have emerged. All of these have been witnessed in West Africa but from a bird's eye view. By having these events happen closer to home, both Americans and Canadians can learn more about how best to contain an outbreak and hopefully reduce the loss of life.
The most interesting knowledge gained from the public perspective is how difficult the virus is to contract and the realization it is not airborne. When Duncan was at home in between his visits to the hospital, he was continually within airborne distance of family, friends and others. He had come into such contact with up to 100 people. Though they are still in the 21 day window for possible infection, none have exhibited any symptoms. If the virus could be spread by air, many, if not all of these people would have become ill. Yet, even his closest contact, his love interest Louise, did not become sick. This should not only offer scientific perspective but also should alleviate the fears of the hundreds of people who may have come into contact with the now infected nurses.
The second piece of useful information is medical in nature and deals with options for treatment and their effectiveness. To date, several experimental therapeutics have been designed to help Ebola patients fight off the disease. They include names such as ZMapp, TKM-Ebola and brincidofovir. All of these have been used to some extent on various patients although they have provided inconsistent results.
As the three current cases, as well as the other three patients flown from West Africa tell us, there is a better likelihood if treatment happens earlier on in the infection process. Moreover, the use of transfusions from patients who have recovered from infection may prove to be useful. Duncan did not receive this option and died; others have and survived. Although this is hardly a scientific study with only a few cases, the prospects for future consideration look good if only to test the theory.
The final lessons apply to health care authorities. When dealing with a virus known to occur abroad, local health care systems should expect a steep learning curve when the pathogen finally arrives. When SARS hit Toronto, everything from patient transfer to choice of personal protective equipment to the experience of health care workers treating patients had to be re-evaluated due to the spread of the virus to health care workers. Now it seems is the States' turn.
The infection of two nurses caring for Duncan has put the entire concept of protection into review. The use of protective equipment is a significant problem as it is the primary means for protection. If done right by qualified personnel, the chances for spread would have been minimized. To do this requires training and practice; only those familiar with the proper protocols should ever go into these rooms. If not, the risk for contamination and infection is high and in this case, occurred.
The need for a harmonized communication system is paramount or infection will spread. A lack of smooth channels between departments within the hospital led to a combination of confusion and misguidance. Thanks to the whistleblowers, other secondary factors such as lack of proper equipment and disposal of medical waste appeared to be mishandled. Then there was the overall morale of those working inside, which seemed to be poor at best. While this could be expected, there was little questioning of the hospital when it apologized for its handling of the situation.
Finally, health care systems need to both dictate and enforce isolation rules for workers. Forcing a person to stay at home -- or at least in the same city -- for 21 days may seem unsavory. But as learned from the recent developments involving the nurse who traveled to Ohio, ignoring the order is not a valid option. While there is little likelihood anyone will become infected as a result of her voyage, the overall panic was completely unneeded.
Many will say having Ebola in America is a very bad sign for the future. For many, this is entirely true. Yet, these lessons can offer us at least some hope moving forward. By understanding the social, biological, medical and administrative aspects to the Ebola story, we can all learn how to be better prepared. In Canada, we have come a long way thanks to SARS. With the information we are gaining from our neighbours to the south, we should be more than ready if and when this virus ever decides to come here.
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