When Ebola protection fails

The title of this article comes from Science in early October.  I must admit it immediately caught my eye. The sub-caption read “Repeated cases among health care workers are a puzzle, but more staff and better training may lower risks.” As I read further it became clear that the article was describing experiences in Africa. One of the doctors who became infected said, “I am fully convinced that I did not contract Ebola in my work in the treatment unit.” Others opined they felt safe working in an Ebola treatment unit, but were frightened by the hidden danger from patients whose status is unknown. Nurses recently infected in the US could not pinpoint when their exposures occurred. New CDC guidelines stipulate that those treating Ebola victims wear an impermeable gown, a waterproof apron, two pairs of gloves, boot covers, face shield, surgical hood that covers the head and neck and a respirator. Special procedures for disinfecting gloved hands between steps when removing PPE, disposal of PPE and a separate site designated for the donning and removal of gear are required. When dealing with Ebola victims there is not a “sliding scale” for PPE. One of the physicians in Africa described wearing “light PPE”.  I have no idea how or why he developed that concept. When we are called to transport an Ebola victim, we will do so only if properly trained and equipped. The fact that the CDC came up with “new” guidelines tells us that the term “properly” will continue to be defined dynamically. New information mandates new action. Here are some scary thoughts:

  • “Limited laboratory studies under favorable conditions indicate that Ebola virus can remain viable on solid surfaces, with concentrations falling slowly over several days.” (CDC)
  • In terms of aerosolization, “We just don’t have the data to exclude it.” (Dr. C. J. Peters, University of Galveston)
  • “Our own research that we published with our collaborators demonstrates that Ebola has the inherent capacity to enter lung tissue, human lung tissue, just as influenza does.” (Dr. David Sanders, Purdue University)

Wow! This is just what we need, more conflicting information to ponder. Is Ebola airborne? Are there ways we can get it that have not been described?  Which experts should we believe? Let’s review a little about Ebola and risk literacy in the next Vitals.

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