A strange thing happened to me last Monday when I went to the clinic.
With the report of a man in Texas with Ebola who had been discharged from a Dallas hospital, then readmitted very sick a couple days later, I realized that any patient I came in contact with that day, or any day, might have this deadly virus.
Now we don’t usually think of work in health care as inherently a hazardous profession — say like being a soldier, firefighter or policeman. Yet it has actually always been so. From doctors and nurses who cared for patients with leprosy and bubonic plague in medieval times to those caring for the Ebola epidemic in Africa today, our colleagues in white coats put their lives on the line caring for those who have no other recourse for help.
Emergency workers, ambulance crews, and paramedics are often called into dangerous settings after shootings, bombings, and other catastrophes where the sites are not always secure or safe. They transport people with unknown diseases and unknown risk.
Of course, we have developed methods of reducing risk. Part of annual training at UTMB for all clinical staff includes reviewing universal precautions, which include several levels of infectious disease control. These range from basic hand washing and use of rubber globes to advanced personal protective equipment, including specialized gowns, masks, and in some cases like the Galveston National Laboratory, even hazmat type suits and respirators.
We must presume every patient is potentially infectious and be careful to avoid splashing or contacting blood or other body fluids on ourselves. Thus the term “universal precautions.” This is an ingrained habit and at UTMB we even invite our patients to remind us to make sure we have washed our hands before and after examining them.
So what about the barely contained paranoia or even hysteria some might be feeling about Ebola in Texas? Following basic techniques we already do to protect ourselves from diseases like HIV and hepatitis are essential and effective.
Taking a detailed travel history of sick patients never seemed so important. Having a higher level of suspicion for Ebola as a “not just in Africa anymore” disease will be useful in containing it. And of course, utilizing our best infectious disease isolation procedures, well understood and available in U.S. hospitals, is our best defense to prevent the uncontrolled spread of the disease that is occurring in Africa.
One of the challenges to doctors and nurses in the primary care setting is that we see a lot of people with undifferentiated symptoms. Many are the same ones as the initial presentation of the Ebola virus.
The common flu presents with muscle aches and fever. The garden-variety viral gastroenteritis we see all year round in both children and adults is characterized by vomiting and diarrhea. These are always with us. They are the hoofbeats of horses, not the sound of zebras of rare conditions like Ebola. Yet zebras do exist, and we need to keep a wary eye out for them.
Measles, flu, whooping cough and many other conditions are much more contagious than Ebola so remember to get all recommended immunizations for yourself and your family. When AIDS first hit us in the ’70s and ’80s, people ostracized these patients, avoiding contact, even shaking hands, because of unrealistic fears of contracting the deadly virus.
We discovered that like hepatitis, HIV transmission required the exposure to body fluids, which is also true of Ebola.
Work is under way to develop vaccines and treatments for Ebola. AIDS, once nearly universally feared and fatal, has progressively become a chronic disease due to discoveries from medical research.
In the meantime, don’t panic. Be sensible and be safe. You won’t get it from sitting next to someone in a bus or plane. You also won’t get it from shaking hands, though remember to wash your hands.