Sunday, December 14, 2014

Sending Clinicians to Treat Ebola Patients: Risks and Benefits

In an October 24th analysis, the New York Times reports that MSF has sent 700 doctors and aid workers from around the world to Ebola-stricken countries.  Of these 700, 3 have been infected with Ebola.  This means that each of those 700 volunteers had a chance of infection of 0.4%.  All three infected MSF expat clinicians recovered.  In fact, the death rate amongst EVD patients who have received Early, comprehensive supportive care in the developed world is near zero.  MSF has not been prompted by the risks involved to abandon their patients in West Africa, and we feel that this is the right decision.  Per the example of MSF, IMA will be seeking to better understand how transmission is occurring, and will be taking every possible measure to insure the safety of our clinic workers.

Allowing Ebola to become a permanent endemic disease in West Africa would create a much greater risk and expense than sending expat clinicians over to work in ETUs does.  If Ebola becomes endemic, hospitals in each affected country will have to consider every patient presenting with general illness will be a potential Ebola case- forever.  Initial triage/treatment of each of these cases would expose a number of unprotected clinicians to potential infection.  In West African settings, where many clinicians cannot even afford to use Basic Precautions PPE, this would make providing basic healthcare either horribly dangerous, or impossibly expensive.  In the US, any patient traveling from West Africa, with general illness symptoms, would have to be treated as an EVD patient until proven otherwise- forever.  To give some insight into the costs this would create: 1 MSF-style suit of PPE costs ~$80 and can only be used once.  This $80 does not include the PAPR recommended by the American Nurses Association.  Every ambulance, clinic, and hospital with potential for coming in contact with an EVD patient would have to keep unexpired stocks of this equipment on hand, and donning this PPE is only the first step in the isolation/treatment process. Imagine all the funding that would be pulled away from other medical programs, just by this PPE requirement.

If the current EVD wildfire in West Africa is not extinguished, but instead is only banked down to a slow endemic smolder, there will always be a threat of a spark traveling to a transit center in a large developing country.  Imagine Ebola in the slums of Rio, Mumbai, Lagos, or Jakarta.   Airport detection measures are notoriously unreliable, and there will not always be a clever Dr Adadevoh to provide an early, correct interpretation of the vague symptoms of Ebola.

The West African Ebola Epidemic is the first great epidemic of the Age of Globalization.  It is safe to assume it will not be the last, nor the most frightening.  It is safe to assume that not every epidemic will occur so far away from America.  The International Community's response to this public health emergency will set the precedent for future responses.  In the history book of the future, will our children read that we acted with courage and compassion, and sent in teams to treat patients?  Or will they read that we stood back, full of fear and indifference, and watched as a country collapsed and a new deadly disease became endemic?

No comments:

Post a Comment