Chief Leader – October 28, 2014
by SARAH DORSEY
As huge monitors projected images of the woman on stage donning and doffing layers of Ebola-resistant clothing, Oct. 21 health-care workers leaned over to each other for a play-by-play.
“What about the boots?” said one home-health aide. “Is she going to check them?”
Another commented on the way the educator removed her gown. It looked like she briefly tucked her finger inside the green fabric when removing it. Did she contaminate her scrubs, or even her skin?
Step Up on Precautions
The woman onstage at the Javits Center wasn’t actually at risk, of course: she was merely demonstrating the proper way to treat Ebola victims to avoid being infected.
Her audience was 6,500 health-care workers, some of whom, like those in nursing homes and labor and delivery units, regularly handle bodily fluids that could be contaminated with anything from hepatitis to HIV. They usually know how to protect themselves.
But Ebola procedures are a step up for them. Precautions begin with a long, fluid-resistant gown over the hospital scrubs and calf-length booties over the shoes. Two layers of long gloves follow, along with a hood covering the head, neck and ears, and a face shield.
Not Easily Spread
Despite all the precautions, Ebola is much less contagious than common viruses like the flu, which kills tens of thousands of Americans each year. It isn’t airborne and can only be transmitted once symptoms begin, so people feeling healthy can’t unknowingly infect others.
Even after the initial aches and fever begin, it’s only transmissible if bodily fluids like blood, vomit or feces get into broken skin or onto mucous membranes like the eyes or mouth. And the virus typically begins building to really high levels in bodily fluids once a patient is near death—when she is far too weak to travel.
A Liberian-American man with Ebola who vomited while flying on a commercial airline to Lagos, Nigeria this summer did not infect any of the 200 passengers onboard.
Risk to Health Workers
But health-care workers are particularly at risk, in part because the disease causes profuse sweating, vomiting, uncontrollable diarrhea and sometimes, in its end stages, internal and external bleeding. The bodies of people who die are also extremely infectious.
Only two people are known to have caught Ebola on U.S. soil, both Dallas nurses who cared for a dying patient without the proper gear.
One recovered and was discharged from the hospital last week, and the family of the other has announced that she is virus-free.
On Oct. 23, Dr. Craig Spencer, who recently returned from a medical mission in Africa, became the first Ebola victim diagnosed in New York. But city and state officials had already begun to take precautions against the deadly hemorraghic fever, which has killed at least 4,800 people this year in the West African nations of Guinea, Sierra Leone and Liberia. The Centers for Disease Control reported more than 9,900 cases in those countries as of Oct. 24, though the actual total is likely much higher.
Most in U.S. Survive
Although the death rate in parts of West Africa has topped 70 percent, the picture in the United States has been very different—at least 85 percent of the handful of people treated here for whom outcomes are known have survived.
That’s likely due to early and aggressive medical treatment. Though there’s no vaccine or cure for Ebola, the American survivors were rehydrated early, and their electrolytes balanced intravenously. Here, patients can also receive oxygen, antibiotics for secondary infections and, as they become available, experimental drugs.
At least three patients also received blood plasma from a missionary doctor who survived; it’s believed that antibodies that his body developed to the disease may help other patients fight it.
Official Reassurances
Mayor de Blasio and Governor Cuomo have tried to minimize panic about the disease while emphasizing that the city was prepared for its arrival.
Some of the efforts are driven by the Federal Government: last week, John F. Kennedy and Newark airports were designated by the Department of Homeland Security as two of five airports in the country through which all flights originating in Ebola-infected countries would be routed.
All passengers on those flights are being subjected to special screening before they can enter the country, including temperature checks, and will be monitored for 21 days for symptoms.
At the Javits Center event, hosted by Local 1199 of the Service Employees International Union and the Greater New York Hospitals Association, Mr. Cuomo and Mr. de Blasio addressed the health-care workers along with several city, state and Federal health officials and doctors.
‘Keep the Anxiety Down’
“Keep the anxiety down; keep the fear down, because it’s unnecessary and it’s not right,” the Governor said, urging listeners to explain to their friends how the disease is spread.
Mr. de Blasio praised the health workers as “first-responders” and noted that there is cause for optimism in the Dallas nurses’ improvement.
People who call 911 with a fever, vomiting or other possible Ebola symptoms are now asked if they’ve traveled to West Africa recently or if they’ve had contact with anyone with the disease. Emergency medical workers are sent a code, F/T for “fever/travel,” to warn them to take precautions.
A spokeswoman for the city Health Department said the agency has been working with local hospitals to ensure they have adequate equipment. The Health and Hospitals Corporation is conducting Ebola drills and is implementing a buddy system for health workers to check each other for mistakes and problems with protective equipment.
Mr. Cuomo also announced that eight state hospitals would provide specialized Ebola care. Four are located in the city: Mount Sinai Hospital, Bellevue Medical Center, New York-Presbyterian Hospital and Montefiore Medical Center in The Bronx. Bellevue is the only one that’s part of the HHC network.
Union: FDNY On Top of It
Emergency Medical Service workers’ union President Israel Miranda said in a phone interview that he was “very impressed” with Fire Commissioner Daniel Nigro’s response to the scare so far.
“They’re ahead of the game at the Fire Department; the Commissioner has been very receptive to the unions and has actually implemented some of my ideas right away,” he said.
Two units in each borough with experience in hazardous materials have been designated as Ebola responders and have been handling the couple of fever/travel calls received each day, Mr. Miranda said. They’re already equipped with full-body hazmat suits designed to protect them from volatile chemicals. The idea is to minimize exposure until the rest of EMS can be properly trained in Ebola precautions.
The department has also ordered more than 5,000 suits specially designed for biohazards like Ebola, which are expected to arrive in the last week of October, he added.
The front-line health-care workers at the SEIU event weren’t so optimistic about their readiness.
Nurses Have Doubts
Three nurses from one of the four Ebola-designated hospitals immediately answered “no” when asked if they felt their hospital was prepared. They said there is a large African patient population at the facility.
“You know, the only people who know how to do this properly are people in the O.R., who [don protective gear] 15 times a day,” one of them said. Another added that individual teams should be getting hands-on demonstrations instead of just seeing them on a big screen.
They agreed that they needed to practice the techniques, especially when taking off contaminated gear, which is often the most dangerous moment. But they believed it was unlikely they’d be given the resources.
Uniformed Firefighters Association President Stephen J. Cassidy wrote an opinion piece for the New York Post last week arguing for a travel ban from affected countries, in part to protect his members, who provide first-line medical care and enter strangers’ houses for both fire and medical calls.
Obama Resists Pressure
A travel ban is favored by the American public and has become a politicized issue after Congressional Republicans and some Democrats have urged one, but President Obama has rejected the idea.
“The President took the number-one option off the table,” Mr. Cassidy said in an interview. “It’s a political move. And this is too important an issue to be making political moves. My members aren’t happy and I think most of America isn’t happy.”
Public health experts, however, have nearly unanimously opposed such a ban, saying that it has been ineffective during previous outbreaks of SARS, the flu and HIV. It could worsen the current outbreak by encouraging patients to hide their symptoms and travel histories, they say, and by restricting the flow of aid and goods into and out of the affected countries, allowing the outbreak—driven largely by poverty and poor health systems—to spiral further out of control.
Charlene Obernauer, executive director of the New York Committee for Occupational Safety & Health, called for mandatory implementation of the Centers for Disease Control guidelines protecting health-care workers. While she said “we are confident and encouraged by our state’s handling of this emergency,” she urged that all workers who have contact with the public be given information about the disease and that the adequacy of specific protective gear be carefully evaluated.
No comments yet.