Here are the highlights of an update on Ebola in the United States:
1) The first wave of contacts of Thomas Duncan, the Ebola patient in Dallas, have approached the end of their incubation without any new cases of Ebola appearing. This includes the household contacts that actually cared for him.
2) None of the health care workers who encountered Duncan the first time he arrived at the hospital and was sent home have tested positive for Ebola. This is significant because those workers wore minimal protective gear as the diagnosis was not considered. This has given some insight into the infectivity of the disease as it did not spread until he was very sick and there were large amounts of body fluids to negotiate.
3) The fact that there are no new cases has given our health care system time to gear up and be more prepared.
Previously, the news revealed three serious failures in the identification and response to a potential Ebola outbreak.
• Failure To Isolate
When the Liberian national Thomas Eric Duncan was admitted to the hospital with symptoms of Ebola, and thus contagious, he was not put into isolation, but rather, was in patient care space for a significant amount of time, surrounded by other patients and hospital staff. This failure opened a major window of opportunity for the virus to be transmitted to others.
• Failure To Protect
The emerging story about personal protective measures from the medical staff is in contrast to that promulgated by administrators at Texas Health Presbyterian Hospital. It is clear that inadequate personal protective measures were put in place to prevent transmission to the nursing staff, resulting in the infection of two nurses in direct care of Mr. Duncan. Initially this was blamed on a “breach in protocol.” It is clear that the nursing staff for Duncan were not provided with any formal protocol or effective protective equipment from the hospital leadership.
• Failure To Quarantine
A major error in judgment was made when nurse Amber Vinson consulted with the appropriate authorities and received approval to travel via airplane, with known exposure to an Ebola patient and in the setting of a new low-grade fever. This failure to aggressively enforce quarantine for persons exposed to the deadly Ebola virus may have far reaching implications.
As clinicians, we must, in the end, make our diagnosis on objective, historical facts and on-going evidence. My current diagnosis of the Ebola situation is this: inadequate recognition and inadequate initial response, creating an uncertain future outcome.
Dan Carlin, MD, is founder of the WorldClinic, a global concierge telemedicine practice. For more information on how you can become a member, visit www.worldclinic.com.
