It’s been very troubling to hear what has been happening in Dallas, Texas. The three known Ebola infections there can and should have been prevented. Clearly the health system has failed the front line team on the ground there. Here are the errors as they piled up:
- The staff at Dallas Presbyterian Hospital did not classify the first patient, Eric Duncan, properly when he was first admitted;
- The nurses (and all hospital staff) have not been trained to care for Duncan, since DPH is not a designated infectious disease hospital;
- Nurse #1, the second patient, appears to not have had the proper protective equipment to care for Duncan;
- Nurse #2 should not have been allowed to travel. Voluntary home confinement after shifts with infected patients would be the correct protocol;
- The CDC did not take the recommendations of protocols in preparedness and equipment from Doctors Without Borders (who have been caring for Ebola patients in Africa).
Without overstating the threat, Ebola is still very infectious. To put it into perspective, in a drop of blood from someone infected with HIV you would find about 1 million viruses; in a drop of blood from an Ebola patient, the viral count is closer to 50 million. In other words, there are 50,000 times more Ebola viruses per blood drop compared to HIV which makes it highly contagious if precautions are not in place.
I was a medical student when HIV was rampant in our hospitals in the 1980s. We didn’t know what exactly we were treating, but I was confident that the protective wear recommended was adequate. HIV is also a virus which spreads through body fluids. Clearly, it appears, even professionals are lacking the knowledge and training to use adequate protective gear. The nurses in Dallas, though fully gowned, gloved and masked still got infected. Fifty percent of the health workers in Africa get infected and die.
This is a huge worry for me, as it must be for all health care providers. It is my hope that Canada’s health care system is well equipped to contain the transmission of virus. We must learn from the American experience now and recall what we did to effectively control the outbreak of SARS in Toronto years ago.
My concern is currently hypothetical. However, I’m not optimistic that our Canadian hospitals will be spared a case or two of Ebola. Hopefully, we will contain the spread of infection—we must do better than what has happened so far in the United States.
For now, the important measures you can take are to limit travel to hot zones and establish a preparedness plan for your business. The Public Health Agency of Canada has issued a Travel Health Notice, advising Canadians to avoid non-essential travel to Guinea, Liberia and Sierra Leone, and to follow special precautions if travelling to Nigeria or the Democratic Republic of Congo. I also suggest minimizing air transit through Paris and Brussels. They are airline connection hubs for West Africa and the rest of the world.
Fear is a significant mental burden. It’s almost as dangerous as the infection itself. If a case of Ebola does emerge in Canada, some degree of economic turmoil is likely. Limiting your risk and having a contingency plan in place is the wisest course of action.
Elaine Chin, MD
Founder, Executive Health Centre