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We Need A Frank Discussion On The Risk Of Spreading Ebola

This article is more than 9 years old.

Earlier today a Manhattan doctor was taken to Bellevue Hospital and evaluated for possible Ebola infection. As reported this evening, the test came back positive. The physician, in his thirties, had been in Africa working with Doctors Without Borders (MSF) for a period of weeks.

The doctor returned to New York, via Brussels, around October 14. He felt sluggish in recent days. Last night he went bowling in Brooklyn. Today he developed nausea and a high fever. The NYC Fire Department delivered him to Bellevue, one of the eight hospitals in New York State designated to handle Ebola cases.

What’s clear is that Ebola can change a person from healthy to sick, fast. Better journalists don’t fear-monger. I get that. But they don’t temper the truth either.

This is a very different sort of virus than what we’re used to managing in the United States, or in modern cities anywhere. R nought, a concept that spread earlier this month, suggests that an Ebola-infected person will infect, on average, fewer than two other people – purportedly less than the same for Hepatitis C or HIV. But those numbers can mislead, because if an Ebola-infected person infects two others, it’s over a course of days or weeks of acute illness, rather than over months or years.

Fortunately, thousands of New York health care workers received detailed instructions at the Javits Center and elsewhere earlier this week. My colleagues have told me there’s a greater sense of preparedness in some NYC hospitals, including Bellevue. At a meeting for physicians I attended on Tuesday, the concerns (appropriately) focused on nurses and others who have the most physical contact with infected patients.

Based on those training sessions, purchasing of better protective gear for workers and – perhaps most importantly, adoption of a city-wide preemptive strategy for dealing with new Ebola cases in the hospital setting, essentially learned from mishaps in Dallas – chances are that this doctor’s situation will be managed carefully and smartly by his team.

NYS Governor's Office (image accessed 10/23/14)

Meanwhile health care workers in western Africa, and now elsewhere, are at risk. That is a serious ethical concern we need to sort through. Some friends and colleagues have suggested that all doctors and nurses who have even indirect or theoretical contact with Ebola patients not be allowed to, essentially, do anything in the public realm. But I think that an unsound recommendation, among other reasons because we need physicians and others who will be willing to do the work – to take care of Ebola patients and help contain the outbreak.

But those same physicians and nurses, lab techs and counselors everyone else in the business – like the rest of us, patients and ordinary people – need to know what to do, touch, not touch – how to minimize the potential for Ebola to spread in the public realm. That sort of advice is still lacking from the CDC and other public health officials.

So how do you clean a subway car? Or a bowling ball? Or the handrail of an escalator? The doorknob of a waiting room? I swim in a pool most days. Is there a certain level of chlorine that kills Ebola? (And is the health department monitoring that, and sending out advisories?) Do food, utensils or water glasses pose a risk? The list goes on.

Most of us understand that the virus is not airborne. Noting comparative statistics about the flu and guns – which indeed are big and more frequent killers here in the U.S. — is not helpful in terms of reducing Ebola’s risk, however small, or fear. It is a form of avoiding the issue. These are reasonable questions.

Ordinary people, patients I know, are seeking guidance on this – and not false or patronizing reassurances – that the virus is nothing to worry about. We, or health departments, can’t possibly “trace” everyone post-diagnosis – all indirect contacts of a patient who’s been in a city for a while. But we can and should know how to protect our hands and how the virus might spread in a community, so that we might better prevent that from happening.

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