What’s Your Ebola Plan?

OK, why pretend?  Most folks are at least a bit worried about Ebola and more so, since the new cases in Texas that resulted from treatment of a patient who brought the disease with him from Africa.  Given that background, let me share the evidence for preventing the spread of Ebola, which I have distilled from the literature published on the subject since 1976, the year the disease was first identified in humans.

http://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html

What is Ebola (Ebola Hemorrhagic Fever)? Ebola is a s viral disease which has emerged from and intermittently caused outbreaks of human disease and death since 1976.  The virus is found in wild African fruit bats and this is thought to be the reservoir in the wild (fruit bats).  Human epidemics are thought to have started as a result of hunting and eating wild animals and spread from person to person through contact with body fluids of infected individuals.  Care givers are at highest risk of catching the disease through contact with infected patients.  There is little evidence that the disease is spread through any other means of transmission.  Prevention is challenging and there is no specific treatment for the disease.  Mortality rates are greater than 50% in the best of hands.  http://jid.oxfordjournals.org/content/179/Supplement_1/ix.long

Based upon my review of the literature, these are the basic Ebola facts and rules:

1. Isolation: http://www.merriam-webster.com/dictionary/isolation = the state of being in a place that is separate from others

2. Quarantine: http://www.merriam-webster.com/dictionary/quarantine = the period of time during which a person that has, or may have the disease is isolated (separated from others) For Ebola, full quarantine is 42 days (twice the longest known incubation period).  But it is important to know that the virus is found in semen of men months after they have recovered from the disease.

3. Contact Precautions: http://www.who.int/csr/resources/publications/EPR_AM2_E7.pdf = gown, glove, mask, hand washing, disinfection and decontamination, and control of patient crud (excretions and secretions) to prevent the spread of the disease beyond the patient being treated.  For Ebola, disinfection and decontamination can be accomplished with chlorine and alkali.

4. Hand Washing (with soap and water): http://www.cdc.gov/handwashing/ & https://www.youtube.com/watch?v=vYwypSLiaTU = wet, soap, scrub, rinse.

5. Decontamination and Disinfection: http://phc.amedd.army.mil/PHC%20Resource%20Library/EVDVehicleDecontaminationTIP_13-031-0914.pdf = Chlorine and Alkali kill the Ebola virus, but the excretions, secretions, parts and bodies of dead Ebola patients will have to be dealt with by communities and Ebola treatment centers.

From the facts, I would recommend these TopTenTargets™© = T^{3™©Â}  to prevent panic and the spread of Ebola.

1.  Isolation/Quarantine: If you think you have Ebola, stay home and separate yourself and keep all your crud isolated and bagged until it is proven that you do NOT have Ebola.

2. Isolation/Quarantine: If you think you have been in contact with someone who has confirmed Ebola, stay home, separate yourself from others and stay in Quarantine until it is proven that you do NOT have Ebola.

3: Isolation/Quarantine: 42 Days for any patients at risk (those in close contact with an Ebola confirmed patient)

4. Isolation/Quarantine:  42 Days all Ebola infected patients and all of those who have symptoms and signs that might represent Ebola infection, until they are confirmed virus free (up to 42 days)

5. Isolation/Quarantine: 42 Days all Ebola health workers.

6. Isolation/Quarantine: In Ebola epidemic areas all healthy patients who get sick should assume they have Ebola till proven otherwise.

7. Hand Washing: All healthy people should wash their hands regularly and for certain after any CONTACT exposure to the sick, or crud of the sick.

8. Contact Precautions: All caregivers should always follow contact isolation precautions.  This includes family, friends, official and unofficial care givers.  When you do not have proper protective gear, keep your distance from anyone who might have Ebola.

9. Isolation/Quarantine/Contact Precautions: All people from Ebola epidemic areas should be considered carriers of the Ebola virus, until proven otherwise. Quarantine 42 days.

10. Keep your wits about you: It may seem harsh, but when in doubt, call for help and isolate yourself and the suspected Ebola patient, until proven otherwise.

The bottom line? Ebola is a killer virus and modern man has no experience with this bug.  Mortality rates above 50 % and rapid easy spread seem to be hallmarks of the disease.  There is no treatment.  Prevention is based upon isolation and quarantine of the sick.  Health workers, family, care givers and contacts need to be isolated and quarantined as well.  Proper protection from infectious materials, disinfection and decontamination is a must. My suspicion is this: faulty care and failure to decontaminate properly are resulting in increased spread.  This includes flawed use of personal protective gear.

IF I had the disease, I would want to be cared for at home by a specialized team.  Home care by mobile care teams in mobile care units would be the smartest and safest way to prevent the spread of Ebola disease.  Those who need or opt for specialized care might have to be moved out to Ebola tent cities where patients and care givers can be cared for and quarantined properly.

This is serious … not at all business as usual … time to get ready and have a proper Ebola prevention plan.

Questions or comments?

Please speak up and, if you care about health and health care, please join us @www.VeritasHC.org.

Have a sweet day.

Dr. Mike