With regard to the November 2014 Ebola scare in the United States, do you think the public health and medical professionals involved in the Ebola cluster investigation followed proper protocols? If so, what best practices were used? If not, what could have been done differently?

 

With regard to the November 2014 Ebola scare in the United States, do you think the public health and medical professionals involved in the Ebola cluster investigation followed proper protocols? If so, what best practices were used? If not, what could have been done differently? Remember to cite references where necessary.

When responding to classmates, provide additional critiques on approaches used by public health and medical professionals during the U.S. Ebola cluster investigation. Response must be 300 words.

1st Discussion post for response:

Communities depend on public health organizations to “come to their rescue” and prevent epidemics from becoming pandemics. It is important that proper protocols are followed to ensure the safety of the public and to maintain trust from the community. When public health officials “drop the ball” community members are less likely to be cooperative during a state of emergency which inhibit proper handling of cases. According to one study, there is a conspiracy among certain individuals who believe the government created AIDS to kill minorities, and another 10% did not trust their provider to give them appropriate medical care (Whetten, et al., 2006). With that said, there is a lack of trust within certain populations. Adding to this distrust, I don’t believe the Ebola scare was handled as well as it could have been, and I’m not convinced that proper protocol was followed by the medical professionals.

The crisis management plan was not followed appropriately and there were many improvisations made which lead to deaths that could have been prevented. According to one article’s documentation of the timeline, the first patient, Mr. Duncan was initially sent home from the hospital with antibiotics because the diagnosis of Ebola was missed, he was then formally diagnosed with Ebola days later on September 30th; Within the first five days after diagnosis there were 15 people being monitored for symptoms, after the first five days there were reports of over 80 people were being monitored and by 10 days after Duncan’s diagnosis he was dead (Andrew, Arlikatti, Chatterjee, & Ismayilov, 2018). There were 76 medical personnel that came into contact with Duncan and it was reported that they wore so much protective equipment that they actually increased the risk of contamination, for this reason the Centers for Disease Control and Prevention (CDC) had determined that it was the Hospital’s fault for the spread and admits that they did not have enough capacity to contain the crisis despite their earlier claims (Andrew, Arlikatti, Chatterjee, & Ismayilov, 2018).

The WHO declared a level 3 emergency, which is the highest level of emergency in an attempt to cease the spread of Ebola, there were reported “overwhelming demands” due to the outbreak that the WHO could not contain without assistance, they would need help of other organizations (decisive government action such as bans on travel and trade) to meet all of the response needs for a disease of this complexity (World Health Organization, 2015). The CDC did a good job training airport staff to screen individuals traveling from West Africa (where the crisis began) to prevent cross-border transmission. From what I’ve gathered, the Centers for Disease Control and Prevention thought they could handle the outbreak, but they were overwhelmed with the severity of the disease.

The 2014 Ebola scare ended on March 29th, 2016 when the World Health Organization (WHO) lifted the Public Health Emergency of International Concern (Simon A. Andrewa, 2018). This spread could have been prevented starting with Mr. Duncan, if Ebola had been caught during his initial hospital visit he could have been isolated and monitored. The medical professionals should have worn appropriate personal protective equipment, opposed to over-compensating and wearing excess/unnecessary layers which would have reduced contamination.

References

Andrew, S. A., Arlikatti, S., Chatterjee, V., & Ismayilov, O. (2018). Ebola crisis response in the USA: Communication management and SOPs. International Journal of Disaster Risk Reduction, 243-250.

Simon A. Andrewa, S. A. (2018). Ebola crisis response in the USA: Communication management and SOPs. International Journal of Disaster Risk Reduction, 243–250.

Whetten, K., Leserman, J., Thielman, N., Swartz, M., Whetten, R., Stangl, D., & Osterman, J. (2006). Exploring Lack of Trust in Care Providers and the Government as a Barrier to Health Service Use. American Public Health Association, 716-721.

World Health Organization. (2015, January). Key events in the WHO response to the Ebola outbreak. Retrieved from World Health Organization: https://www.who.int/csr/disease/ebola/one-year-report/who-response/en/

2nd Discussion post response:

According to the Centers for Disease Control and Prevention (CDC), the Ebola virus has been around for many years, even before it was discovered in 1976 (CDC, 2018).  The first outbreak occurred in the Democratic Republic of Congo which is near the Ebola River (hence the name) and the second was in South Sudan, which is about 500 miles away from the first location (CDC, 2018).  These two cases were thought to be related by public health officials; however, it was discovered later that they were indeed two separate viruses (Zaire ebolavirus and Sudan ebolavirus) (CDC, 2018).  It was concluded that these two viruses must have come from two separate sources and then spread to those affected in that specific area (CDC, 2018).  The CDC states that both “viral and epidemiologic data suggest that Ebola virus existed long before these recorded outbreaks occurred” (2018).  Once Ebola had been discovered, it was noted that most of the outbreaks of the virus had occurred in Africa (CDC, 2018).  It wasn’t until the 2014 outbreak that the virus became a global epidemic as it had spread across the borders to the United States from southeastern Guinea in West Africa (CDC, 2018).

While Ebola virus is caused by a group of viruses, only four are known to cause disease in people (CDC2, 2018).  While it had been projected that West Africa was going to have an outbreak of the Ebola virus disease (EVD) in 2013, the local and international health groups were not prepared for the outbreak in Guinea (Cenciarelli et al., 2015).  Recognizing the disease was difficult as it presented very similarly to other diseases such as malaria and Lassa fever (Cenciarelli et al. 2015).  The first weeks of the outbreak went essentially unnoticed until more severe symptoms developed and deaths occurred.  The CDC and the WHO were involved in issuing reports to help define the geographical areas affected.  With the untrained healthcare personnel, inability to track down probable affected persons, allocation of resources to handle the outbreak, and local distrust in the teams handling the outbreak from the communities affected (Cenciarelli et al., 2015); the spread of the disease came to the United States.

It is with this that I believe the trouble began.  I think that our public health officials as well as our medical personnel were not prepared for an epidemic of this type.  As the Ebola virus is a type of viral hemorrhagic fever (VHF), hospitals are required to complete an assessment, which is called the hazard vulnerability analysis assessment, to identify the risk to its employees and select the appropriate personal protective equipment (PPE).  Scientists have come to the conclusion that the Ebola virus is transmissible via respiratory/aerosol as well as through contact with blood or body fluids, regardless that the CDC advised that it cannot be transmitted by airborne  (Eddy & Sase, 2015).  Problems associated with the outbreak in the U.S. are “misdiagnosis, patient morbidity, and the secondary infection of health care workers wearing various levels of PPE” (Eddy & Sase, 2015).  For example, in the Dallas Ebola case, the man “died of hemorrhagic fever 14 days after” he was originally diagnosed as having a sinus infection (Eddy & Sase, 2015).  Misdiagnosis, miscommunication, and treatment delay are possible errors that ultimately impacted the patient as well as the healthcare professionals (nurses) that provided care for him (Eddy & Sase, 2015).  Both nurses were then taken to separate research facilities (one of the National Institutes of Health and the other was the CDC) to be cared for as these sites contained resources equipped with Ebola emergency treatment areas (Eddy & Sase, 2015).  The hazard vulnerability assessment isn’t always completed within various hospitals utilizing the same standardized methods and “a high degree of variation exists in scope and process” (Eddy & Sase, 2015).  Hospital emergency preparedness depend on correct assessments being completed and should include a “worst-case-scenario” as well as designating a hospital command system, designating the proper PPE, procedures, and completing simulation disaster drills to prepare the staff for these types of emergencies (Eddy & Sase, 2015).

In conclusion, I do not feel that proper protocols were followed.  Perhaps if the hazard vulnerability assessment were utilized more stringently in all healthcare facilities, the first hospital would have been ready for such a disaster as Ebola.  The proper PPE must be utilized in compliance with Occupational Safety and Health Administration (OSHA) standards as well as the awareness that the InterAgency Board (IAB) assigns a high-risk classification to Ebola (Eddy & Sase, 2015).  With that being said, the standard of care for healthcare staff safety would be the utilization of fully encapsulated garment for healthcare workers and a respirator with a sealed helmet/hood that overlaps the garment (Eddy & Sase, 2015).  The use of higher level PPE can be worn, such as a self-contained breathing apparatus and may even contain HEPA filtered ventilators in a pressurized suit (Eddy & Sase, 2015).  It is further recommended that correct and immediate diagnosis along with algorithms to determine specific contact sources, operational communications systems, and bio-surveillance information be available for future hazards (Eddy & Sase, 2015).  As always, the proper PPE must be worn to protect our health care workers.

 

References:

Cenciarelli, O., Pietropaoli, S., Malizia, A., Carestia, M., D’Amico, F., Sassolini, A., …Gaudio, P. (2015). Ebola virus disease 2013-2014 outbreak in West Africa: An analysis of the epidemic spread and response. International Journal of Microbiology. doi: 10.1155/2015/769121

Centers for Disease Control and Prevention. (2018). History of Ebola virus disease. CDC.gov. Retrieved from https://www.cdc.gov/vhf/ebola/history/summaries.html

Centers for Disease Control and Prevention2. (2018). What is Ebola virus disease? CDC.gov. Retrieved from https://www.cdc.gov/vhf/ebola/about.html

Eddy, C., & Sase, E. (2015). The 2014 Dallas, Texas, Ebola incident: Global implications to all-hazards preparedness and health care worker protection. Journal of Environmental Health, 78(2), 28-32.