Thursday, October 16, 2014

Obligatory Ebola Post

With Ebola very much in the news, I might as well weigh in on the subject.  People are starting to panic because a second nurse who treated Thomas Duncan has come down with the disease.  By way of perspective, let me point out the following:

First, of all of Duncan's contacts outside the healthcare system, none have shown and Ebola symptoms.  Granted, we still have about two weeks to go before we can definitively clear them, but the general consensus is that the time of maximum peril for his contacts has passed.  (And if this sounds like empty reassurance, keep in mind how quickly these two nurses have become infected, although their exposure was later).

Second, the hospitals that treated medical and missionary evacuees have managed to keep any of their healthcare workers from being infected.

Third, if reports coming out of Dallas Health Presbyterian Hospital are to be believed, the hospital did a poor job of maintaining the necessary isolation protocols for a deadly infectious disease.

So, what conclusions would I draw from this:

First, the risk to people outside the healthcare field is minimal.

Second, with proper precautions, we can protect our healthcare workers.

Third, most of our hospitals are not properly equipped and trained to do so.  This last conclusion is based on the assumption that the hospitals that safely treated evacuees are the exception and Dallas Presbyterian is the rule.  First of all, the hospitals treating evacuees knew in advance what they were dealing with.  Dallas Presbyterian did not.  We can assume this will be the general rule:  Hospitals treating evacuees will know what is coming in.  Hospitals dealing with walk-ins will not. Furthermore, we don't have all that much experience dealing with really, really deadly infectious diseases and therefore are not all that good at taking proper precautions.  It seems safe to assume that the Duncan case will serve as a huge wakeup, and that hospitals will start learning and practicing better isolation in the future.  This is both good news and bad news.

The good news is that we will start screening better for Ebola, asking about travel abroad, and preemptively taking isolation precautions, and doing a much better job dealing with any future cases.

The bad news is that there will be a lot of false alarms and panics, and that these will be costly. Consider post-9-11.  There were a lot of false alarms about possible airline hijackers.  Flights were delayed.  Airports or whole wings of airports were shut down.  Passengers were attacked and forcibly restrained.  It was a major nuisance.  But that was all it was.  Delayed flights, inconvenience, and even a few physical assaults are not a serious threat.  People joked about them because it was the sort of thing you can joke about.

False alarms and panics in the healthcare system are a whole lot more dangerous and harmful.  Huge amounts of resources will be devoted to learning isolation and protection.  Extreme isolation measures will be unnecessarily deployed in numerous cases.  These will waste resources that might have been put to better use.  There is shutting down the entire Dallas Presbyterian Hospital to avoid possible risk to other patients.  Emergency rooms and urgent cares may start turning away patients to better isolate possible Ebola cases.  People may start fearing healthcare facilities and refusing to go for fear of being exposed to Ebola.  These will leave many other ailments untreated -- including many that are contagious.

In short, the risk of Ebola to people outside the healthcare system is minimal.  But the risk to our healthcare system from panic is a serious concern.

At the same time, thus far the danger of panic seems to exist mostly on internet sites, while ordinary people are very sensibly going on about their lives.

And finally, there has been talk about a travel ban to and from Liberia, Guinea and Sierra Leone, except for emergency personnel.  Cancel all tourist visas to and from these countries and require everyone else to undergo 21 days quarantine.  What would I think of that?  I am open to persuasion either way.  Intuitively it is appealing, but if you can convince me it is not worth doing, I am open to persuasion.  Certainly if the disease gets as badly out of hand in these countries as the World Health Organization fears (10,000 cases a week by two months from now) I see little choice but to impose such a ban.  At the same time, if there start being real signs of a panic in our healthcare industry, that alone may be grounds for a ban.

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