- We are at Day 22 / 21 for the standard Ebola incubation period. None of the original contact list in Dallas have become positive. This is very strong evidence that, contrary to hyperbole being sold by "Ebola experts", the virus is not transmitted efficiently nor is aersolized. We note the virus that arrived in Dallas is the most highly mutated Ebola Zaire strain ever documented. And yet, no pandemic. And yet, not even an outbreak among the original contacts.
- The two infected nurses represents accidental protocol breach under conditions associated with maximal risk- the handling of high volume, highly infectious fluids. While there have been concerns that some of the additional healthcare workers (~76 in total) may have been infected, we have not seen this yet. This represents a new incubation period to monitor, where we are at Day 10 / 21. We are about to depart the "sweet spot" of Ebola incubation, which is 7-10 days.
- The nursing unions, which are arguably one of, if not the most powerful lobbying group in American healthcare (because they are the workforce backbone of any medical facility) has emerged as a powerful driving force to re-examine what true medical preparedness means. It has become increasingly apparent the physician's political voice in this country is muted when compared to this powerful lobbying voice.
- We continue to note several key problem areas Stateside:
- Confusion exhibited by EMS personnel regarding signs and symptoms of Ebola. Ebola is often associated with "influenza-like illness" (ILI) versus a febrile gastroenteritis. There appears to be a lack of awareness of CDC's page on this matter.
- An inappropriate focus on symptoms over a travel history. The travel history should take precedence.
- That the answers to a travel history question should not necessarily take precedence, but rather a high index of suspicion. This point naturally makes people nervous and typically upsets public health professionals. But that is the reality with indigenous Africans coming from the affected countries- they are not being fully transparent about their risk.
- An apparent inability to critically assess (or even have access to) the latest medical intelligence regarding countries and areas in Europe (i.e. Spain) and the US (i.e. Dallas) where a travel history truly is important. We have been surprised to see questions asked regarding travel to Dallas, for example. This is the direct result of hype.
- At a national level, physicians continue to express concern regarding the following:
- Many facilities still have not trained their staff.
- A multitude of questions regarding the "real" protocol that revolve around observed discrepancies between what researchers wear in BL4 labs versus what MSF / Doctors Without Borders uses versus what CDC says to use versus what was executed in Dallas.
- A significant hesitancy regarding the safety of automated blood sample analyzers used in the typical urban hospital when an Ebola-positive specimen is inadvertantly submitted for processing. This concern is separate and distinct from concerns regarding potential contamination of the tube transport system in the hospital.
- There has been a serious erosion of trust in CDC, which is now manifesting as a resurgence of not only questions regarding "Ebola becoming airborne" (and hence, "pandemic potential"), but a return to questions regarding vaccine safety and now-debunked questions about autism and the MMR vaccine. Perception of a breach in trust on Ebola has led to a re-examination of other questions... a process that has severely eroded this country's public health. Fortunately, the resurgence of questions about the vaccines reflect a minority opinion (so far).
- Refusal to restrict travel by non-US citizens from the affected countries, in the context of an uncontained regionalized epidemic, virtually guarantees another translocation in the coming weeks to months. We are more concerned about translocation by airflight versus a land crossing from countries to the south of our borders.
- Disturbances in the stock market has been documented and are expected to continue, especially if another translocation occurs. We observe significant mythology and misinformation regarding Ebola and associated risk among stock market analysts. They frequently move to "doomsday scenarios" and hold belief in an "airborne virus" and "pandemic potential". Hype continues to inappropriately disrupt the markets.
- Another translocation will likely further erode trust in our national institutions of public health and political leadership.
There is a conceptual conflict being presented, when viewing this through the lens of biodefense. The civilian medical infrastructure has historically resisted preparedness for an intentional release of a biological weapon. Resistance to the smallpox and anthrax vaccines were examples. This resistance to biodefense-related countermeasures overlapped resistance writ large to vaccines such as seasonal influenza- an ongoing echo of the anti-vaccination sentiment. Some of us viewed these developments with concern, as such erosion of public trust (and specifically, healthcare worker trust) carried significant implications should this country be attacked successfully with a bioweapon. Inherent resistance to vaccination implies less national resilience in the face of an attack.
This country certainly needed to gain experience dealing with high threat biological agents such as Ebola. These are excellent drills for what might be observed in the context of a biological attack. And the world needs to see that we are able to handle not only the agent but the element of surprise adeptly. But the element of politicalization and fear in this country runs counter to such a notion of resilience.
This country needs to "keep calm and carry on" and demonstrate we are able to embrace the facts (e.g. there was actually incredibly low risk of Ebola spread in recent reports of airflights and cruise ship "exposures"). Otherwise, we show the entire world we are fragile, weak, and unable to manage infectious diseases that are containable.
There is more at stake here than simply management of the Ebola disaster at-hand.