After
caring for Thomas Eric Duncan, the only American to die from Ebola, many nurses
at the Dallas hospital ended up sleeping at the facility for three weeks. They
were afraid to go home and risk infecting their children. Ebola has forced
healthcare workers to make difficult choices. On the one hand, doctors and
nurses swear an oath to care for the sick. On the other, fear for themselves and
their families strikes deep. Ebola presents a real dilemma that has literally
brought some nurses to tears.
Pandemics
are all about the likelihood of infection and the number of chances to infect. Fortunately,
in the case of Ebola, the likelihood of infection is relatively low. Our best
available data suggests that the virus requires contact with bodily fluids,
particularly when the patient has become truly ill. Although the early fever-only
stage is troublesome, it’s only later, when the patient is
visibly sick, that the number of viral particles increases and the chance for
infection becomes a real concern. If sick patients could be isolated, the
pandemic would quickly end. Patients would either recover or (unfortunately)
pass, but either way, any further infections would end. With these factors in
mind, here are some considerations for our healthcare providers and for
individuals.
1. For the average American: Relax, this
is a disease of healthcare providers. The chance of the average person coming
into contact with an Ebola patient is vanishingly small. More Americans have
been married to Kim Kardashian than have died from Ebola. Do you worry about
being hit by lighting (twenty-three deaths last year)[1] , or dying from the flu (thousands die
every year)? If not, you probably shouldn’t
worry about Ebola. However, and this is generally true, if you are sick, you
should probably limit your contact with others. And if you are sick with a high
fever for several days in a row, contact a healthcare professional.
2. For healthcare workers: Ebola is a
disease that affects care-givers more than it does patients, and while
healthcare providers have a responsibility to care for the sick, healthcare
organizations also have an equal responsibility to care for their doctors,
nurses and other workers. Considering that hospitals are small cities with
people constantly coming and going, thus increasing the chances for
transmission of disease, we should limit the number of people caring for the
sick. In the case of the many nurses caring for the patient in Dallas, ideally
there would have been just one person, supported by experts at a distance
3. Technology: I spend a lot of time
thinking about telemedicine and care coordination. This is a perfect
opportunity to put the technology to use. Traditionally, access to care is
limited by distance. In this case, access should be limited by the risk to
providers. Telemedicine has reached a point that it can offer more than simply
video. It can be a tool for care coordination over cell phones and other
available devices.
4. Find a cure: This seems self-evident,
and governments are working on vaccines and other drugs to limit the infection.
I mention this now because there are still millions of people who refuse to get
vaccinated for all sorts of diseases that are worse than Ebola.
5. Get the right person to care for Ebola
patients: The best person would be an individual immune to Ebola—an Ebola survivor. Ebola survivors, of
whom there are thousands, could be quickly trained to be medical assistants, working
with patients but assisted by remote specialists. This could help stem the tide
in Africa, but there are still logistical issues for America.
6. Monitor but don’t close the border: Closing the border will only lead to
desperate measures. Imagine what you would do if you thought the US was the
only place to save your loved one. We need people to disclose when they are
worried, not hide their concerns.
Unfortunately,
after thousands of deaths in West Africa, Ebola will almost certainly fade back
into the shadows. This pandemic is an opportunity to think more broadly about
how our healthcare system responds to infectious diseases. We can do a better
job, but it will take original thinking about how we care for the sick . . . and
more concern for the healthcare workers we put on the front lines.
Tags:
Ebola, nurses, protecting health care workers, healthcare technology,
telemedicine, care coordination
