Thursday, October 16, 2014

Worse than useless

Up to this point I have been vocal in my support for the Centers for Disease Control and Prevention in its handling of the Ebola outbreak in Dallas.

And I'm still a supporter.  No other agency or entity, public or private, has the resources and expertise necessary to contain and eliminate this outbreak.

But I'm disturbed by this morning's development.  It was reported yesterday that a second Dallas nurse who cared for the original Ebola patient, Thomas Eric Duncan, has now tested positive for Ebola infection.  That's unfortunate, of course, and it increases the urgency of the review of and training in Ebola protocols.  There are but two real possibilities:  the protocols weren't followed, or the protocols are defective in some material respect.

To infect a person, the virus must enter the person's body.  Entrance can be gained through the various orifices of the body or through the mucous membranes. A person properly encased in a PPE suit is protected from the virus during that time.  The problem occurs when it becomes necessary for the person to leave the suit.  "De-gowning" is a difficult task when the outside of the PPE suit contains Ebola.  While health care workers need to be careful about putting on the PPE correctly and avoiding tearing or punctures while being around the patient, de-gowning presents a problem.

Think about it:  How would you take off your clothes without touching the outside of them with any part of your body? 

There are ways to do it, but they are difficult to learn and follow with 100% accuracy.

I am confident that the CDC will be able to solve the protocol problem.

But this morning brought a disturbing report about that second Ebola nurse.  Apparently she found herself in Cleveland for personal reasons, knowing that it was possible that she had been exposed (if not probable, given that one of her coworkers had contracted the disease), and running a low-grade fever, 99.5°.  She called the CDC for guidance, and she was told that because she hadn't reached the known threshold for being contagious--100.4°--she technically did not meet the guidelines for quarantine, and she was OK'd to fly.

It may well be that this woman wasn't contagious, that she posed no risk to her fellow passengers.  But the CDC's decision--which, granted, probably wasn't made by higher-ups in the agency--is tone-deaf to a remarkable degree.  Given that it's difficult to transmit the virus to begin with, at least if you are well enough to walk onto an airplane and have only a low-grade fever, the chances are excellent that no one will become infected.  But the CDC ought to know that outbreak management is not a game in which the adversary knows or follows the rules.  Even if the science says the disease is transmissible at 100.4° but not 100.3°, you don't run up to the margin like that.  The CDC official who told this nurse it was OK to fly was taking an unnecessary risk.  Any fever in a person who has likely been exposed should be treated as though the disease is active.

Failing to follow protocols is useless.

But elevating the protocols over common sense is worse than useless.

However, it's still not time to panic.  It's also not time to create a new layer of federal bureaucracy over the CDC.  What they have in place might not be perfect, but it can be made perfect with more common sense and direction.

What we could use, though, is a Surgeon General.  Obama has nominated one, but the GOP is stonewalling the nomination as a favor to the National Rifle Association because of some semi-controversial remarks the prospective SG made about gun regulation.

We could also stand to end the sequester as it applies to the CDC and the NIH.  These entities, which provide essential services that the private secton can't or won't.

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