Two days ago a 26 year old nurse in Dallas, Nina Pham, tested positive to the virus. She was one of Thomas Duncan’s seventy caregivers. Her diagnosis puts a pretty smiling petite face on a horrendous disease, and one can only hope that by discovering the disease early she will be luckier than the man she treated at Texas Presbyterian hospital.
We don’t know exactly how she caught the virus from Duncan. She wasn’t one of the responders who came into contact with him during his first visit to the hospital, after which he was sent home with antibiotics and Tylenol. Evidently she had worn the gear dictated by the CDC, “gown, glove, mask and shield,” yet still got sick. The CDC stated there must have been a “breach in protocol” but Ms. Pham doesn’t recall when it may have happened and neither do the investigators who have interviewed her. The CNN article notes “Or the problem could have been something else entirely.”
“Something else entirely” means maybe we don’t know this disease as much as we think we do, and after 40 years of research that isn’t very much.
Take for example the question of whether the virus is spread through the air. The CDC states unequivocally “Ebola is not spread through the air or by water,” but others aren’t so sure. “We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks,” writes Lisa M Brosseau, ScD, and Rachael Jones, PhD in commentary published by the Center for Infectious Disease and Research Policy (CIDRAP). According to CIDRAP Brosseau and Jones are nationally recognized experts on infectious diseases, not tin-foil hat posters from ZeroHedge.
Here’s the distinction between an airborne infectious disease and one spread through aerosoles. The common cold is considered to be an airborne virus, potentially spread from one person to another without landing on any surface. An aerosolized one is defined by Brousseau in a 2011 research paper as one where disease is spread through the air between people, or as Brousseau writes, “defined as person-to-person transmission of pathogens through the air by means of inhalation of infectious particles. Particles up to 100 μm in size are considered inhalable (inspirable). These aerosolized particles are small enough to be inhaled into the oronasopharynx, with the smaller, respirable size ranges (eg, < 10 μm) penetrating deeper into the trachea and lung.”
Notice any difference? Let me know if you do because I don’t.
I would expect that scientists would disagree about how a relatively new disease like Ebola spreads, but the CDC needs to be honest and it needs to assume the worst. The medical workers currently treating Ms. Pham need to assume the virus can be spread through the air and a 10 micron virus will spread through a facemask or around a plastic shield as if it weren’t there. They should wear respirators.
Americans need the Truth. Truth will deter panic more than empty assurances from pseudo-politicians in the CDC.
Update: A second hospital worker has tested positive to the disease, and it’s increasingly likely that Ms. Pham didn’t make a mistake removing her protective gear. Instead it’s looking like the CDC protocol for handling this disease is wrong and needs to be changed.
Since the advent of antibiotics and common vaccines we have been spared the pandemics that raged through our history like Bubonic Plague, Smallpox and Spanish Flu. These diseases not only killed millions, they changed our history countless times. Since these were tamed, however, the only large outbreak has been HIV so most of the experience of public health professionals has been with this virus. Unfortunately HIV and Ebola are very different viruses. HIV is quite weak outside the body. It breaks down quickly on surfaces and can only penetrate the skin through a wound. Ebola on the other hand is much stronger. It can remain virulent on surfaces for long periods. It easily passes through the skin and doesn’t need to gain entry to the body through a cut the way HIV does. Worse, the those infected shed much more of the virus through diarrhea, uncontrolled bleeding and vomiting. HIV doesn’t cause such symptoms making it much harder to transmit.
My guess is that the CDC’s protocols are based on HIV and if so, they are inadequate and must be changed. “(CDC director Dr. Tom Frieden) outlined new steps this week designed to stop the spread of the disease, including the creation of an Ebola response team, increased training for health care workers nationwide and changes at the Texas hospital to minimize the risk of more infections.”
Mistakes are going to be made, and demanding perfection is unrealistic. As long as we learn from the mistakes and deal honestly with their consequences we will eventually control the advance of this disease. Am I scared? Of course I am. This is a nasty disease but what other choices do we have?
Update 2: It gets worse. The second hospital worker, a nurse named Amber Joy Vinson, flew from Cleveland back to Dallas just 12 hours before she came down with a fever. The plane stayed in Dallas overnight and then was used for several flights the following day before being taken out of service today.
The likelihood of a passenger on any of those flights catching the disease from Ms. Vinson is low but it is not zero, and given the failures so far to stop the spread in Dallas I’m wondering whether it would have been too much to ask for hospital management and the CDC to make the following rule:
If you are being actively monitored for potential exposure to the virus (as Ms. Vinson was), don’t fly.
It seems like common sense to me.
One other note: We will soon be entering cold/flu season and millions will be developing fevers that are not caused by Ebola, providing a perfect screen for the disease to spread in. While perfection from the CDC may be too much to ask, we should expect them to at least up their game.
Update 3: Ms. Vinson knowingly boarded the plane with a temperature of 99.5 degrees. This is below the threshold of 100.4, but what the heck…
Update 4: March 1, 2015 – Pham survived the disease and is now suing the Texas Health Presbyterian Hospital for failing to protect her and the other caregivers.