Summary: Ebola care requires full-body containment uniforms and full bleach wash-downs; Ebola is the most dangerous disease health care workers in the world are currently treating. Please read this and be prepared.
I have a Liberian brother-in-law and a cousin who is a nurse, so I have been following the Ebola epidemic very closely. And when the Dallas Ebola case was handled so badly, I became much more concerned about America’s preparedness.
My friend Christine Peterson shared a Facebook post by David Rostcheck about proper Ebola treatment practices, with follow-up information from him about Ebola’s lethality for health care workers specifically. I consider this information so critical that I want to maximize its reach, so with David’s permission I am reposting it here.
I have never made this appeal before, but I am making it now: please share this information among your family and friends, especially among anyone you know who is a health care worker. If you are a health care worker, please show this information to your coworkers, to your management, and to your union (if any).
If you have any concerns with the correctness of this information, or links to other useful resources, please share them with me in the comments. I am in touch with David Rostcheck and will work to ensure this information is correct and maximally useful to the heroes of this epidemic: the health care workers who are at greatest risk.
Over to you, Mr. Rostcheck.
Ok. Dear all friends who work in health care: I have important information for you about Ebola that you’re apparently not going to get elsewhere; please read.
Ebola is a level 4 biohazard. This means that to be handled in a laboratory, it must be handled in a dedicated lab with full-isolation suits (which cover 100% of your body and have their own air supply), with the room’s air and water outputs sterilized. The lab must be accessed only through decontamination areas (generally several in a row) where your suit can be decontaminated with bleach, which must sit wet on the suit for 10 minutes, then with UV radiation, and where you can shower immediately after removing the gear. That is the appropriate safety protocol for handling Ebola. The reason for this is that Ebola, unlike the “tame” common hospital infectious agents we have co-evolved with, is a “raw” (newly emerged) virus. It is extremely hazardous and extremely lethal.
I realize, as do you, that the hospital environment is nowhere near biosafety level 4, but I want you to realize how far away it is. A live Ebola patient is an extreme biohazard, even more so than a laboratory sample. Using hospital PPE to protect against Ebola is like wearing a raincoat to protect against automatic weapon fire. Your PPE must cover 100% of your body, it must be washable with bleach, and it must actually be washed with bleach. Paper anything or disposable anything is completely insufficient protection, and if anything has a special order for taking it off, you need different PPE because nothing is safe to take off until 100% of its surface has been washed with bleach and air dried. You’d be much better off with a Tyvex suit and full-face respirator from Home Depot sealed together with duct tape (and it might be a very good time for you to go buy these). You can’t have people moving freely between spaces without decontamination or 70 people caring for one person. You need to treat it as though it will kill you if you mishandle it, period.
If you work in health care and you have not previously read The Hot Zone, a non-fiction book about Ebola outbreaks, you need to buy it and read it. Then study the protocols from Doctors Without Borders (MSF). They require things like dedicated decontamination rooms, decontamination teams spraying each others’ suits with bleach, and step-in pans of bleach solution separating rooms. They manage to do this in West Africa so we can manage to do it here. This is what the hazmat teams wear and they’re going to be fine, but you guys need to protect yourselves. You need to know more than your supervising residents or hospital administrators, because the gear and protocols they are espousing is a complete joke. Ebola is a hazardous material and you need to treat it as such to protect yourself.
It’s not 100% fatal, but it seems like hospitals are proving to be far underestimating, rather than overestimating, the hazard and that their protective measures are geared towards much less lethal infectious agents. I understand the desire to combat public panic, but hospitals also seem very unprepared for a seriously dangerous microbe. The way to stop an epidemic is to shut down its lines of transmission and health care workers especially need to have a much more realistic view of Ebola’s transmissibility and lethality. I feel we need to improve the accuracy of the information provided, especially to health care workers.
Here are a few key resources:
- An infographic of a treatment center from Doctors Without Borders.
- A Doctors Without Borders FAQ on the disease, with some protocol details.
- a CBS video on Ebola protocol in Liberia (shows chlorine bleach spray, step-through bins, double-layer protection, 100% surface coverage).
- An excellent article on how Firestone was able to train its staff to effectively control Ebola in its African operations.
- The definition of biosafety level 4 protocol, from Wikipedia.
- The CDC has improved its Ebola protocols following consultations with Doctors Without Borders.
- A statement by the nurses at the Dallas hospital about exactly how inadequate their preparation was.
- The Center for Infectious Disease Research and Policy publishes a public health note recommending use of powered air respirators for all Ebola caregivers. There is debate about how necessary this is, but judge for yourself after reading the note.
- Unbelievably hopeful story about a young Liberian woman who protected herself with trash bags and nursed three of her four family members through Ebola singlehandedly, staying uninfected herself.
[Ed. preface: Some people say that Ebola is not a significant worry in America because you are more likely to be hit by a car, or any of a number of other common expected health risks.]
Well, your co-workers are more likely to be injured or killed in a car accident on the way to work than to get Ebola unless and until they actually have an Ebola case in their hospital, at which point the situation changes dramatically. Statistically, caring for an Ebola patient is currently the most dangerous professional situation one can currently get into, and probably the most dangerous thing a health care professional will do in his or her life. Here’s the math:
Using numbers from an article from September 25, WHO reports 384 infected health care professionals of 5,843 recorded cases (6.6% of Ebola infections were health care workers); they had a 54.2% mortality rate (much lower than the current 71% overall mortality rate). In Dallas, at a first-world medical system, so far we have seen 2 infected nurses out of 70 health care personnel who had contact w/ the index patient, for an infection probability of at least 1/35 (2.85%), and of course that’s from one patient. Assuming the best possible conditions – no more nurses contract Ebola from the index patient and 54.2% vs 71% chance of dying gives us a 2.85% chance of infection with a 52.2% chance of mortality (dependent events, so multiplying) gives a 1.49% chance of dying from one interaction with one patient.
The biggest killer of Americans is heart disease, with a 1/387 chance of dying in one year, or .25%. The deadliest job in the United States is (er, used to be) commercial fisherman, with a .12% chance of death for working a year of commercial fishing. To put that another way, if you treat one Ebola patient, you are at best 12.4 times more likely to die than if you worked commercial fishing (the most dangerous job in the United States) for a full year, or 6 times more likely to die than you are of the disease that kills the most Americans per year.
At the peak of the (most recent until current) Iraq war in 2004, the United States had 114,000 troops deployed and suffered 849 casualties (.74%). You are twice as likely to die of treating one Ebola patient as in fighting one full year in active combat in Iraq at the peak of the war.
I think we should not downplay the risk to health care personnel. Health care workers are true heroes. Treating Ebola is currently about the most hazardous thing a human being can do; it carries a very high risk of death. Health care workers need to be educating themselves and wearing correct hazardous material handling equipment to survive.