We now have two nurses who were infected with Ebola while caring for a patient. Although they were blamed for "breaching protocol," we know that's not the case now that reports of the deplorable conditions and lack of appropriate PPE and protocols has come to light.
Nurses allege staff worked with ebola patient 'without proper protective gear' | BreakingNews.ie
But even if CDC protocols and recommendations are followed in the wake of this disaster, the question is this:
Are they enough to protect nurses (and their families, and other patients in the hospital, and the public health)?
It sure doesn't seem like it. In fact, I feel confident in saying no, they're not. I've been doing some research, and I want to share my findings with my fellow nurses.
According to the World Health Organization, 4,493 people have died from Ebola, and 427 healthcare workers have been infected during patient care. 236 of them have died. For every 10 patients with Ebola, one nurse has been infected. And nearly half of them has died. Some of them did not have the appropriate PPE (like the nurses in Dallas). Some did.
Ebola is a Biosafety Level 4 pathogen -- the most severe category. The CDC has this to say about BSL-4 pathogens:
"The microbes in a BSL-4 lab are dangerous and exotic, posing a high risk of aerosol-transmitted infections. Infections caused by these microbes are frequently fatal and without treatment or vaccines. Two examples of microbes worked with in a BSL-4 laboratory include Ebola and Marburg viruses."
http://www.cdc.gov/training/quicklearns/biosafety/ (slide 10)
There is a HUGE discrepancy between safety guidelines issued by the CDC for healthcare workers and workers in research laboratories. Why should this be? Labs handle Ebola under controlled conditions. Nurses handle Ebola when it's being spewed out in projectile vomit and explosive diarrhea. But the guidelines for nurses don't come close to those for lab workers, which is outlined here for handling BSL-4 pathogens, including Ebola:
Laboratory practices
- Change clothing before entering.
- Shower upon exiting.
- Decontaminate all materials before exiting.
Safety equipment
Facility construction
- The laboratory is in a separate building or in an isolated and restricted zone of the building.
- The laboratory has dedicated supply and exhaust air, as well as vacuum lines and decontamination systems.
http://www.cdc.gov/training/quicklearns/biosafety/ (slide 11)
Yet for nurses (and others in contact with a patient), the CDC only recommends an isolation gown, gloves, a surgical mask or respirator, and goggles or a face shield.
http://nsnbc.me/wp-content/uploads/2014/10/CDC_Ebola_Ebola-Guidelines.png
Why is this? It's the very same virus, the very unforgiving virus that kills 70% of those it infects, and in a horrifying way. There is no vaccine, and there is no cure. These are the reasons it is classified as a BLS-4 pathogen.
Yet the CDC keeps reassuring us that it's 'hard to catch' Ebola, and it's only spread through contact with body fluids. So why are those lab workers dressed like astronauts? Because Ebola is a very unforgiving virus that kills 70% of those it infects, and in a horrifying way. There is no vaccine, and there is no cure. Even if it's hard to catch, you don't want to catch it. That means every precaution must be taken.
And why do they say it poses a 'high risk of aerosol-transmitted infections' (link above), but then tell us it's only spread through direct contact?
Any pathogen can be aerosolized. Droplets form and hang in the air for as long as 90 minutes when a toilet is flushed, a patient sneezes or coughs, or during procedures likely to produce aerosolized droplets, such as intubation.
In speaking about Ebola transmission, Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota said this:
"Some scientists are urging health officials to acknowledge what they don't know. At a meeting on Ebola Tuesday, one infectious disease researcher told an audience at Johns Hopkins University in Baltimore that scientists should get comfortable with uncertainty and be honest with the public about gaps in knowledge about Ebola.
"We're making this up as we go. We have to be mindful that we're making it up. One of the worst enemies we can have today is dogma."
http://www.usatoday.com/story/news/nation/2014/10/15/nurses-protest-ebola/17302987/
Even if it does spread only through direct contact, workers should use the maximum protection needed. Why? There is absolutely no room for second best or probably good enough.
"Ebola kills 50% to 90% of people who become infected, which is much higher than any other infection we are used to dealing with. The 2009 influenza pandemic killed less than 0.01% of those infected, and SARS killed 15%. The price of getting it wrong with flu guidelines might be a week in bed, but for Ebola it is far more likely to be death."
http://nsnbc.me/2014/10/15/nurses-becoming-infected-ebola/
Even if you use more and better PPE than the CDC recommends -- and you're an expert in using it -- you might not be safe:
"Dr Sheikh Hummar Khan was the leading viral haemorrhagic fever expert of Sierra Leone, who had already treated over 100 Ebola patients using full personal protective equipment when he died from Ebola.
"Personal protective equipment guidelines should not be based on presumed mode of transmission alone, but also on uncertainty around transmission, on the severity of the disease, on health worker factors, and on available treatments or preventions."
"Health authorities such as the US CDC are conveying certainty that Ebola cannot be transmitted by any means other than direct contact. But it's a very poorly studied infection compared with other diseases and the sum of the evidence shows significant uncertainty around transmission.
There is no scientific evidence to explain why health workers using personal protective equipment are becoming infected, and nor has there been a reasoned approach to trying to explain it.
Instead, the blame has been placed on the health workers for lapsing in personal protective equipment protocols."
"If MSF (Doctors Without Borders) has more comprehensive protocols on protective wear, it is hard to understand why Western countries are not heeding them."
http://nsnbc.me/2014/10/15/nurses-becoming-infected-ebola/
I strongly urge nurses to campaign for PPE and protocols at least on the level of that utilized by MSF. Don't accept anything less. You deserve it, your families deserve it, the public deserves it, and the other patients in the facility deserve it.
The people 'in charge' of this crisis have made enough mistakes. Please don't become one more of them.
Please watch this excellent video of how nurses at Emory protect themselves:
Nurses show how they prepare to treat Ebola patients
