Brantly and Writebol. Image: Reuters
At least one, but possibly two U.S. citizens with Ebola is due to fly from West Africa to Atlanta during the next few days. Barbara Reynolds spokeswoman for the CDC in Atlanta said that she is not aware of any Ebola patient ever been treated in the United States before.
Emory Hospital in Atlanta has issued a statement saying it is well prepared to receive the patients, and that it has the facilities to safely care for them without any risk to the public.
Let’s hope and pray they are right.
Two Americans are infected, Dr Kent Brantly and Nancy Writebol who are said to be in a grave condition. Apparently a serum has been made from the blood of a child who was cured of Ebola and that serum, although experimental has been offered to Dr Brantly. He is said to have refused the treatment, insisting it be given to Writebol.
On at least five occasions the CDC has made mistakes in handling deadly pathogens. According to the LA Times:
Dangerous germs, including anthrax, botulism and a strain of bird flu, were improperly sent among government laboratories in five incidents during the last decade, according to the Centers for Disease Control and Prevention, which said it had closed two labs and had imposed a moratorium on shipping deadly pathogens.
The announcement of the previously undisclosed incidents comes days after the CDC said scientists had discovered six vials of the smallpox virus in an unused storage room at the National Institutes of Health campus in Bethesda, Md.
This of course is not counting the exposure of 86 workers to anthrax in June, and as the article states comes just days after vials of the smallpox virus was found lying at the back of a shelf in a cupboard….
I have great sympathy for those suffering from this awful disease. Up to 90% of those who contract it will die a terrible death, but bringing those people to the United states, UK and Europe will not alter that fact. What it will do is increase the risk of this virus spreading.
One mistake with this, and people are going to start dying across the United States. From the point that the Ebola patient leaves the isolation ward in Africa the risks to the rest of the world start to grow.
It’s likely the patients will be transferred in pods called aeromedical biocontainment systems. These systems are specifically designed to allow medical staff access without exposing themselves to the virus. They are not particularly sturdy structures as you can see from the photograph.
Image: U.S. Center for Disease Control
There is not much room on medivac planes, and with possibly two patients to care for it is unlikely there will be enough spare equipment to deal with all possible emergency scenarios. Although bodily waste can be removed from these pods, doing so on the aircraft would be incredibly dangerous. Usually a specialized flow air system, inside a biocontainment air lock would be required to remove level four biological waste safely.
The logistics of transporting a patient with Ebola, particularly Ebola Zaire, the strain causing the current outbreak are horrendous:
- From the isolation unit along corridors to ambulance or helicopter
- From the ambulance or helicopter to the airport.
- Then they have to get the patient actually onto the plane.
- A flight of ten hours + depending on where exactly they are taking off from.
- Transfer from the aircraft on arrival in Atlanta.
- Travel by ambulance or helicopter to the Emory Hospital.
- Transfer to the isolation unit.
All of this needs to be done, twice if both patients are returned home, without snagging or breeching the flimsy plastic tent of the unit.
Now remember, these patients have Ebola Zaire, a condition where ALL bodily secretions are infected. The condition causes diarrhea and vomiting, a high fever causing the patient to sweat, and bleeding from every orifice. These symptoms will not conveniently stop because the patient is in transit to the United states, or Germany, or anywhere else.
All of these secretions and bodily fluids will need to be dealt with without emergency back-up for upwards of 15 hours.
One mistake and the medical team doing the transport, as well as any ancillary staff involved will be open to risk of contamination. One splash of bodily fluid missed when the airliner is decontaminated after the trip will expose cabin crew and future passengers to harm. The virus has been shown to remain active both in dry and liquid forms for several days outside of the body. The fact that infection can occur from those preparing Ebola victims for burial suggests possible airborne spread as persons without any cuts or grazes have become infected when preparing bodies for disposal.
…are also at risk when handling the bodies of deceased humans in preparation for funerals, suggesting possible transmission through aerosol droplets. In the laboratory, infection through small-particle aerosols has been demonstrated in primates, and airborne spread among humans is strongly suspected, although it has not yet been conclusively demonstrated.
It’s likely that just having an Ebola patient in a major U.S. city is likely to see a surge in patients presenting with flu -like symptoms as this is how Ebola first presents itself. People will quite rightly be worried. Some of concerns that I personally have are:
- Will the medical staff treating the patient(s) be confined to the hospital or will they return to their normal lives at the end of each shift?
- Is this a one off or are more patients likely to be flown out of Africa?
- As laboratory aerosol spread has been noted where is the vented air from the biocontainment airlocks pumped to?
- Will biohazard waste be incinerated on site at the hospitals or will it have to be moved to commercial facilities?
- How many layers of protection will stand between visitors of the patients and the patients themselves?
- As the virus takes up to 21 days (with a mean of 4 to 9 days) to incubate how often will staff tending the victims be tested for the virus?
Here is the statement released by Emory Hospital:
Emory University Hospital has been informed that there are plans to transfer a patient with Ebola virus infection to its special facility containment unit within the next several days. We do not know at this time when the patient will arrive. Emory University Hospital has a specially built isolation unit set up in collaboration with the CDC to treat patients who are exposed to certain serious infectious diseases. It is physically separate from other patient areas and has unique equipment and infrastructure that provide an extraordinarily high level of clinical isolation. It is one of only four such facilities in the country. Emory University Hospital physicians, nurses and staff are highly trained in the specific and unique protocols and procedures necessary to treat and care for this type of patient. For this specially trained staff, these procedures are practiced on a regular basis throughout the year so we are fully prepared for this type of situation. An Emory University spokesperson declined to provide additional details.
There are so many possibilities for something to go wrong in this situation it genuinely frightens me to think about it. Ebola Zaire is a medical nightmare, and at this point in time that nightmare has a decent chance of escaping my dreams and becoming reality.
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Contributed by Lizzie Bennett of Underground Medic.
Lizzie Bennett retired from her job as a senior operating department practitioner in the UK earlier this year. Her field was trauma and accident and emergency and she has served on major catastrophe teams around the UK. Lizzie publishes Underground Medic on the topic of preparedness.