As the Ebola crisis in West Africa worsens and fears spread about a potential major outbreak in the US, physicians are looking for information-not just about the disease but how to protect themselves and their workers. In a series of video-taped discussions Alfred DeLuca, Jr., MD, an internist and infectious disease specialist in Manalapan, NJ and Peter Salgo, MD a professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons in New York, NY offered advice and shared their insights on the growing threat posed by the lethal virus. "It's scary--Let's talk about scary," Salgo said.
As the Ebola crisis in West Africa worsens and fears spread about a potential major outbreak in the US, physicians are looking for information—not just about the disease but how to protect themselves and their workers.
In a series of video-taped discussions Alfred DeLuca, Jr., MD, an internist and infectious disease specialist in Manalapan, NJ and Peter Salgo, MD a professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons in New York, NY offered advice and shared their insights on the growing threat posed by the lethal virus.
“We’ve got a crisis going on,” Salgo said, “Ebola mortality is as high as 70%--some say 50%--and in West Africa the World Health Organization predicted we will see 10,000 new cases a week.”
Though both physicians were on the frontlines a care during the early years of the AIDS epidemic, this pathogen in some ways is more frightening than HIV, they said. "It's scary--let's talk about scary," Salgo said.The US public had been watching mostly from the sidelines,the physicians agreed, until the Oct. 8 death of Thomas Eric Duncan, a visitor from Liberia who was treated at Texas Presbyterian Hospital in Dallas, TX, followed by the news of 2 confirmed nosocomial infections in nurses who cared for him.
Then the questions began for US practitioners.Doctors still do not have definitive answers for many of those, the two physicians said. That includes getting unequivocal information about how Ebola spreads. “We’ve gotten some assurances and one of the big mantras is that Ebola cannot be transmitted through the air,” Salgo said, “Now some experts are couching that statement.”
DeLuca said physicians are right to be skeptical of such absolute statements. “It’s like someone saying the Titanic can’t sink,” he said. The notion that Ebola cannot be spread through the respiratory route defies common sense, he said. “If someone who has bad Ebola coughs on you no one is going to say ‘don’t worry, it’s not transmitted through the air’,” DeLuca said.
Salgo said he wonders whether the two Texas nurses—whom he repeatedly described as heroes—contracted the disease through some lapse in personal protection procedures or if their illnesses show the virus is spreading more easily than acknowledged.“You don’t know without the videotape,” DeLuca said, “this is all conjecture.”Still, they agreed that the most usual means of transmission is clearly through direct contact with body fluids, one of the Ebola facts promoted by the US Centers for Disease Control and Prevention (CDC).The biggest worry, DeLuca said, is not for physicians themselves, but the frontline workers, the people who triage patients in an emergency room, or office receptionists and nurses who are patients’ first encounter. But workers have been getting mixed advice on how to protect themselves, and about how much personal protective equipment is necessary.
“When you see CDC personnel in space suits there is a reason they are doing that,” DeLuca said. “Maybe that is going the extra mile, but not one of those persons would trivialize what we don’t know about this particular virus and how contagious this could become.” Equally skeptical, Salgo said he questions whether the CDC rubric that patients with the virus are not contagious until they start showing high fevers and other symptoms, and that if someone goes 21 days after exposure without those symptoms, there are no risks.
DeLuca dismissed the CDC’s new airport policy of taking patients’ temperatures when their original destination was in West Africa. He said the practice is “silly” and a “pathetic” attempt to stem an outbreak. He strongly favors stopping travel between the US and affected nations in West Africa, DeLuca said repeatedly.
Both said they are convinced that the US must take more steps to prevent a major Ebola outbreak—but that they also believe that will happen.
A major point of debate among physicians has been whether community hospitals are up to the task of caring for Ebola patients.
The CDC position is that with training, that can be done safely. Is the US prepared for dozens of cases?
DeLuca said that will take new facilities.When a patient comes into a clinic or emergency room, or doctors’ office with a fever but there is no immediate reason to suspect Ebola “It wouldn’t take much to break [bio]containment, “ DeLuca said.A better strategy—in addition to making sure doctors and staff have access to protective equipment and training in how to use it—is to set up more places to care for Ebola patients.
Because of the expense of duplicating infection control facilities like the 4 existing hospital with biocontainment units, DeLuca suggested portable units such as those being used in Africa.
“Perhaps we need novel solutions, more portable smaller buildings that would give us the ability to treat patients outside the hospital in prefab units,” he said.
On the plus side, they agreed, are the CDC’s efforts to get hospitals to hold drills and training sessions to help workers protect themselves from infection.
Panic and fear are big enemies they agreed.
Both physicians described conversations they had had with colleagues who were worried about travel, one to Dallas and another about taking a cruise to Puerto Rico.
“When your own colleagues talk that way, that goes to the core of the terror,” Salgo said, “not that the virus is pervasive, but that is so deadly—even one case, you don’t want that.”
The physicians agreed that the current concern about Ebola, and the disease itself, reminded them of their days caring for AIDS patients in the early days of that epidemic. DeLuca said he still treats HIV patients, but remembers the horror of being an intern in the early 1980s at St. Michael’s Hospital in Newark, and seeing young patients “younger than me as an intern dying right and left.”
Both expressed their hopes that new drugs and a vaccine might put an end to the scourge of Ebola, but agreed it was unlikely to happen soon.
Even if a vaccine is developed, that would likely take "a couple of years at the very least," DeLuca said. "It will only prevent new cases and will not deal with the ones that are out there now; it's not a cure," he said.