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Friday, October 24, 2014

Open Letter: Post-Care for Ebola-Zone workers

Dear New York-
We are deeply grieved with all of you that Dr. Spencer, an Emergency Medicine Fellow in training in NYC who volunteered to work with ebola patients in Guinea, has fallen ill.  We pray that he will fully recover, and that no secondary cases will arise.

Some thoughts:
1.  Dr. Spencer is unlikely to have infected anyone.  NO ONE became ill from Mr. Duncan's initial visit to the hospital in TX, when he had mild symptoms. Ebola becomes contagious after the patient is symptomatic.  Decontaminating cruise ships and planes because they were touched by exposed people, in some cases prior to illness and in other cases without any illness at all ever, may not be an effective use of resources.  Following up random subway and bowling alley strangers may not be either.

2.  Post-ebola-care workers need a place to go, because of the climate of hysteria.  In spite of calm pronouncements that people are not infectious until they are sick, panic ensues. Then politically someone has to take action which is justified by the phrase "out of an abundance of caution".  It would be much less expensive to provide a designated 21-day incubation camp near an excellent hospital prepared to care for any post-service cases that arise.  Note that SIM quietly set up an RV camp for potentially exposed people returning from Liberia, kept them quarantined for 21 days, no one got sick, and all was well.   The ebola czar would spend less money designating a place for medical workers to recuperate/isolate/incubate and be well cared-for, than in spending money reacting to the panic that arises with any new infection.  Even though they are not putting people in danger going to the grocery store while well, it is true that human beings facing potentially fatal diseases have such strong denial mechanisms they may block out their initial symptoms.  So if we're going to pour resources into "an abundance of caution", let's put them in making life better for the brave souls who volunteer rather than persecuting and second-guessing them after they return. Perhaps the "sluggishness" reported by the press that preceded Dr. Spencer's emergency trip with a 103-degree fever should have been recognized as a prodrome, but anyone who is recovering from a stressful stint of work, jet lag, and culture shock, can feel sluggish.

3.  Not everyone who returns from West Africa is in the same risk category.  Ebola is transmitted by close contact with sick people.  That means family members, health care workers, and burial teams.  Those are the people who need to be followed up, and need sympathy and care.

4.  Remember the numbers.  Liberia, Guinea, and Sierra Leone are home to about 21 million people.  Ten thousand have been infected with ebola this year.  That is 0.05% or 1 in 2000 people. Horrible, tragic, and way too many, absolutely devastating to any country to lose that many people.  However, not all Africans, or West Africans, or even Liberians, etc. are potentially a danger to anyone.   There are 1,999 safely uninfected people living in those countries for every ONE person who is infected.  Amongst international travelers, only one random guy has become ill.  If 150 people a day travel from those three countries to the USA, that means in the 8 months of the epidemic 36,000 have come to the USA, with one sick.  Just keep that in in mind when setting budgets.

Bottom line:  Spend money and emotional energy and logistical support where it counts.  Send help to the affected countries, and take care of the family members, health care workers, and burial teams.  Prioritize creating safe places for those who volunteer needed care, so they are not hounded and stigmatized and blamed when they return.

A pair of docs


Eric McCloy said...

This makes an enormous amount of sense. In addition to compassionate and well-considered heath care, you've added compassionate and well-considered economics.

lisa said...

Well said, as usual.