The Ebola Hysteria. Where Is The Next Ryan White?

The New York Times reports that the medical staff at Bellevue hospital who are treating Dr. Craig Spencer, the physician who contracted the Ebola virus while working in Africa for Doctors Without Borders, have been shunned and discriminated against throughout the city, even within their own hospital. Businesses have asked them to leave when they find out they are employees of Bellevue. Some nurses who moonlight at other facilities have been told their services would no longer be needed.

Unfortunately, this panic among the general population, and even within the medical community, has been promulgated by the clumsy handling of the issue by the government and specifically the Centers for Disease Control. On their very own website, the CDC states the Ebola virus can only be spread by direct contact. It is transmitted through body fluids or a needle puncture with a contaminated needle. It is NOT spread through the air, by water, or with handling of food. Yet this important information has not been aggressively emphasized as the government has pursued people all over the country who may have flown on a plane that on a previous flight had carried an Ebola positive patient with a very low grade fever. Their mandatory 21 day quarantine also reenforces in people's minds that Ebola is so easily transmittable and so deadly that even people who have tested negative for the virus need to be isolated even though they show no evidence of being infected.

If all of this sounds familiar, then you are right. Back in the early 1980's, America was caught up in another viral disease panic. Its name was HIV. Like Ebola, HIV is not spread through the air or drinking out of the same water fountain. It is now well known that HIV is only transmitted by body fluids or contaminated needles. But at that time, the government's mishandling of the situation led to massive discrimination against HIV patients.

HIV remained in the public conscious as a disease of the damned: the homosexuals, IV drug abusers, and the prostitutes. It was not until a young Ryan White from Indiana came along that put a personal face on the disease. Ryan was a boy with hemophilia. He caught the virus through a blood transfusion at a time when blood wasn't tested for HIV. He faced horrible and ignorant intolerance from children and adults alike. He was banned from attending school. Their family car was vandalized. Store clerks would throw change at his mother to avoid coming in contact with her hands.

Back then, HIV was much more prevalent than Ebola is now. People were familiar with the images of skeletonized HIV patients. There were hundreds of HIV patients in the big cities, making them easy fodder for the major TV news operations of the country. Yet it took the courage of one young man to finally make the country understand that a person who has contracted a disease should be treated with compassion, not as a pariah. With the help of the medical community and the government, people got educated on how HIV is really spread, not just basing their fears and rumors and hearsay.

Ebola is currently in that same early stage of awareness as HIV where people are more fearful of the unknown than the reality. Heaven forbid Ebola will one day reach the same prevalence as HIV. But if it does, we will at least have experienced a similar teaching moment to fall back on and not make the same mistakes all over again.

Why Nurses Have Bigger Cojones Than Doctors

Physicians can be such wimps. You would think that a group of people as smart as doctors would be natural leaders in society when it comes to making medical decisions. Yet we are pushed around by lawyers and politicians with nary a complaint even though we furtively grouse about our predicaments behind the closed doors of doctors lounges. Meanwhile, when nurses feel they have been wronged, they let everybody know about it.

The latest example is Kaci Hickox, the nurse in Maine who had just returned from Sierra Leone after taking care of Ebola infected patients. The state wants her under "voluntary" quarantine for three weeks even though she has tested negative for the virus and exhibits no fever or other signs associated with the disease. Like a good New England rebel, she has defiantly resisted this rule, even riding her bicycle out in public. She claims it is unconstitutional for the state to keep her locked up in her home out of fear and without any evidence.

This follows the defiance of nurses at Brigham and Women's hospital in Boston (must be something about New England that breeds dissenters) who are suing the hospital over forced flu vaccinations. The hospital has called for termination of their jobs if they don't get the shot. The hospital is demanding the vaccinations despite the fact that there is little evidence the vaccine actually prevents the flu or that it is necessary for healthy young people. Besides the lack of efficacy, the vaccine has real potential complications that can lead to a lifetime of disability, like Guillain Barre.

Meanwhile doctors just complain to each other about how difficult our professional lives have become because our decisions are being made by others, usually not even in the medical field.  Instead of doing something about it, we, and our professional societies, continue to kowtow to sharper legal and political minds as we trudge through our daily grind.

Doctors should be leading the charge against mandatory quarantines where there is no evidence of illness. Physicians should be educating the public about why the flu vaccine may not actually prevent the flu and can lead to crippling illnesses. But we don't. How pathetic is that?

Our Hospital's First Ebola (Computer) Virus Scare

Our hospital recorded its first ebola scare today. A woman came in for a routine outpatient procedure. She has been coming to us regularly for months so nobody was especially on guard about any potential health hazard with this lady.

When we opened her electronic medical record, a stunning display popped out. Right at the top of the page, in bold red background lettering, the computer had declared she was positive for the ebola virus. A minor panic nearly ensued as everybody started scrambling for protective gear and wondering how we would all get along as roommates for the next 21 days in quarantine.

Then cooler heads prevailed. A quick call to the IT department confirmed that this was an error. In fact, if we had looked up every patient that was in the hospital at the moment, they all had the same ebola warning. The department was inserting new programming into the system for the diagnosis of ebola, which didn't exist before. Somehow it had crossed over into the live system and infected every patient's chart (pun intended).

After that we all gave a big sigh of relief and laughed at the stupidity of IT. Now we can go back to ignoring the big bold warnings about our patients with MRSA, VRE, MDRO, etc...

Ebola 101 For Anesthesiologists. Bring Duct Tape.

The American Society of Anesthesiologists has released its recommendations for anesthesiologists who might come in contact with the much feared ebola virus. It starts out with a quick FAQ on the nature of the virus. For instance, did you know that even though the virus can be easily eliminated on a dry surface with household bleach, it can live on your skin for up to 6 days? If you live long enough it can survive in breast milk for two weeks, urine and stool for a month, and semen for over 100 days.

The diagnostic criteria for ebola infection is a fever of at least 38.6 C. That partly explains why that one nurse from Texas was allowed to board an airplane after treating an ebola patient; she had a low grade temperature of less than 38 C at the time of her cross country trip. Initial symptoms include headache, GI symptoms, and easy bruising. This eventually leads to DIC and multisystem organ failure. The only treatment is symptomatic and possibly some experimental vaccines and serums. 

The ASA's suggestions for doctors who are treating ebola patients is simple--wear personal protective equipment (PPE) religiously. That means training in how to safely don and doff (their words) the astronaut suits precisely without contaminating yourself or anyone around you. The space suits that we sometimes see orthopedic surgeons wear are not good enough. They circulate air inside the suit with simple fans on the top of the head. These fans blow unfiltered air directly on the operator's face, thereby actually concentrating the amount of virus that the wearer might come in contact with. It's also a good idea to use duct tape to seal off all open spaces between clothing.

Patients will be in isolation for the duration of the illness. They should not be transported anywhere in the hospital. All equipment and personnel will come to the bedside, including anesthesia and surgical equipment in the unlikely event a patient needs an emergency operation. Once in a PPE, the doctor must stay in the suit until the procedure is finished. So don't have that last cup of vente Starbucks before donning the PPE. 

The anesthesiologist in an ebola procedure room will have to be self sufficient. Nobody is going to run in and out of the room because the correct size intubation blade is not present. The anesthesia cart will be taken out of the room and a bare supply cart with the minimum amount of equipment and drugs will be made available. No anesthesia machine either so better get used to using total IV anesthesia. If a patient is coding, no crash team will be able to quickly put on their PPE's to assist with resuscitation. If a patient needs an emergency intubation, personnel may not be able to put on a PPE fast enough before he suffers anoxic brain injury.

These are just some of the issues that all doctors and patients in the future will have to confront in this small cross contaminated world of ours.