Ebola - do we need economists and not medical scientists making decisions? Huge discrepancies between scientists and industry responses.

The 2 flights that the second health care worker made to and from Dallas to Cleveland have already caused ripple effects which are probably driven not by medical science but by fear  and possibly concern about financial impact.

The discrepancies between decisions made by medical scientist and individual businesses are striking

CDC - ok to fly with fever of 99.5 even though you treated patient with Ebola
vs.
Airline- take the plane off for decontamination

CDC - you can't get Ebola from someone who is not symptomatic.
vs.
Hospitals - nurses who flew on same flight as recent case before she got low grade fever are on paid leave.
Schools - closed for decontamination because a teacher was on same flight that CDC ok'ed her to fly on.

Till this panic settles down, we need protocols in place to divert suspects away from the public and "regular" healthcare intake channels.

The psychological impact of a potential patient walking through the hospital to seek out care - touching door knobs, counters, etc and "exposing" tens of people and healthcare workers will be huge and the potential financial impact quite terrible as the hospital in Dallas is finding out.  Yes, medical science tells us that person will likely not be infectious and it is OK for them to seek care using regular channels but once we have a single case like that, the mass fear will take over.  

Hopefully we don't get another traveler with Ebola coming into the USA but this will likely happen.  We hopefully will not make the same mistakes again that were made in the Dallas ER, but that assumes that every healthcare worker in the country is trained and follows the right steps which is highly improbable.

We need to keep our hospitals working smoothly!

We need to put up signs at every healthcare facility entrance that diverts suspected (high-risk) cases to dedicated triage hot lines.  This will reassure the public that it is safe to use the hospitals for their non-Ebola care.

Protect your health care worker - a sign at every hospital entrance

I posted earlier regarding the need for an airport program for patients traveling from West Africa.  It took a few days after the first case in Dallas for the authorities to put something like that in place.

That post also noted the lack of preparedness of the US health care institutions to combat Ebola at this time.  The sense of urgency has just not been there.  Till there is excellent awareness and training in place there is a need to divert any suspected Ebola case away from the regular intake process in hospitals.  Otherwise we will have many more mishaps like the ones in Dallas.

One solution is to have a sign at every hospital entrance that
1.  Tells person traveling from these countries
2.  Who has the classic symptoms
3.  To sanitize hands and
4.  Call a dedicated triage phone line.

Then the appropriate protocols can be invoked.
We need to prevent every preventable exposure that we can.
Every case brings broadening circles fear, monitoring, and disruption that will cause tremendous damage to the economy and the healthcare system at the least and might even save some lives.

Sign for every hospital entrance

The US Ebola Approach - what we are missing?

This story on NPR highlights the mishandling of the first case of Ebola to be diagnosed in the USA in spite of "training" and information efforts.  Numerous officials have claimed that the course of Ebola in the USA will be very different as it will be easy to contain due to better health care facilities and literacy.  The problem is that the focus has been on containment after the fact rather than limiting the early exposure.

We have known for a long time that the current scenario of an asymptomatic person from West Africa entering the USA and then developing symptoms was quite likely to happen.  Let us look at our current approach to this scenario happening and what we could do differently.

Hospitals are training their staff to ask about travel history and symptoms and then invoke the appropriate protocols using checklists.  This approach does not address a potential much earlier point of intervention that would decrease exposure and limit the chaos.

The current approach requires a patient who has traveled to the US from West Africa who gets symptoms to actually get to hospital and navigate the intake process to make it to a provider who may still fail to do the right thing as happened in this first case.  Along the way the patient may use a cab or public transport, touch door knobs, counter tops and railings and be in physical contact with several people. While it is not easy to spread Ebola by contact (usually the patient would have to be quite sick) just the fear of possible transmission and the amount of effort it would entail to track down people at real risk vs those with just insignificant contact would be huge and cripple the system.

This person if he develops symptoms, since he came from West Africa, has only one fear dominating his mind, "Do I have Ebola?"  The  approach needs to be to have this person stay in his hotel room or home and call a dedicated hotline that is manned by a trained person who can invoke the appropriate protocol.

How can we make this happen?  The process needs to start at the international airport where a person first lands.

• There should be signage at the airport informing travelers from West Africa about the hotline if they get symptoms.  They could pick up a sticky note with the phone number and paste it to their passport.
• Each person from West Africa should be given a simple thermometer at entry to the US.
• They should be entered into a database 
• They should be required to check their temperature each day and report it via a phone line/text/website that enters it into this database.
• The hotline phone number should be imprinted on the thermometer cover
• If they fail to enter the temperature, it should trigger someone should contact them.
• If their temperature is >threshold someone should contact them to ensure that they called the hotline.

This seems to be common sense but we are not doing this.  How do we know this?  A recent report by CNN highlights the abject failure of communication at the airport where 3 reporters returning from West Africa got three completely different experiences when they mentioned where they were coming from. The agents were not aware of or could not locate the information regarding how to handle these travelers.

If somehow this step does not work, and the person does end up at a healthcare facility with symptoms without calling the hotline, we need to intervene before they have to navigate the intake process like any other patient.

• Every entrance needs to have signage regarding steps to follow for a traveler from these countries with symptoms
• It should have a touchless skin sanitizer next to the signage
• After using it, the person should be able to use a phone with a speed dial to a trained infection control staff who would direct the patient to appropriate location limiting exposure to others.

Just the one case of the unfortunate Mr. Ducan has highlighted the tremendous effort that it will take to monitor and keep quarantined his approximately 100 contacts.  As more of these cases happen, we will be left with the scenario of a large number of healthcare workers exposed and quarantined.  This will cause a huge burden on our already fragile health care system.

We need to adopt an approach of earlier intervention.  The only risk of such an approach is causing anxiety but it has the potential of preventing exposure of large number of people.  We had many months to prepare for this.  We have a short window when such an approach might still work.  Now that the danger is clear and present, can we do this right?