Ebola: Errata

I need to correct three errors I have made.

Error 1

For some months I have been saying, based on expert advice from various trusted expert sources, that the Ebola virus would be easily contained in Western countries, particularly in Western hospitals. I now recognise that this was an error. Sorry.

It turns out that nurses at Texas Health Presbyterian Hospital in Dallas, according to the director of the National Nurses Union RoseAnn DeMoro, were given inadequate protective clothing; conflicting guidance about treatment protocols; were closely involved in dealing with the patient’s infected projectile vomit and explosive diarrhoea; and worked in rooms where soiled materials were piled up to the ceilings.  All this despite receiving many official directives from the CDC about how Ebola should be handled. It is said that 72 hospital workers may have come into contact with patient zero at some stage.

The nurses' statement (given anonymously, which is probably the best way to find out the truth in these fraught circumstances)  alleged that when Duncan  (US patient zero) was brought to Texas Health Presbyterian Hospital by ambulance with Ebola-like symptoms, he was “left for several hours, not in isolation, in an area” where up to seven other patients were. “Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,” they alleged. Duncan's lab samples were sent through the usual hospital tube system “without being specifically sealed and hand-delivered. The result is that the entire tube system … was potentially contaminated,” they said.

48 contacts in the community are being monitored for exposure. Health workers were not part of this group, because it was assumed they were not exposed. Another health worker has tested positive for the virus (announced today), so we have 2 hospital worker infections arising from the index case. This is stupidity of the highest order, and the management of the hospital need to explain themselves quickly. The union representative may be exaggerating, but she doubts that any US hospital is able to deal safely with Ebola at the moment.

Error 2

I said that HIV was easier to spread than Ebola because you can transmit HIV through sex while still looking healthy. I forgot that Ebola can remain in sperm for 60 days, and in one case probably up to 90 days, such that the 30% who survive Ebola  will be in reasonably healthy looking condition and might have unprotected sex. So, in calculating the spread of Ebola we should factor in some sexually transmitted infections.

Error 3

I retained the idea that, in the case of widespread global spread of Ebola, the Authorities had a Plan B somewhere, in which the conventional narrative about disease control would come into question, and stricter quarantine would be recognised as the one option that works, given strict enforcement. Privately, I assumed this might be found somewhere in the World Health Organisation. Now Dr Bruce Aylward, the WHO Assistant Director-General of WHO's work in polio eradication and humanitarian response, is quoted as saying that the 70 per cent death rate made Ebola "a high mortality disease" in any circumstance. The WHO target is to isolate 70 per cent of cases and provide treatment as soon as possible over the next two month in an effort to reverse outbreak, he said. "It would be horrifically unethical to say that we're just going to isolate people," he said, noting that new strategies like handing out protective equipment to families and setting up very basic clinics was a priority.

His comment on ethics seems to hinge on the concept that it would be wrong to “just isolate people”, in that they ought to be isolated (I presume) but provided with protective equipment. That is fine, but the phrase “horrifically unethical” reveals a one-sided approach to ethics. I assume that Dr Aylward would concede that it would be “horrifically unethical” to let infected persons spread the disease by coming into close contact with others. Therefore, ethics must balance the needs of infected persons against the need of other people not to become infected.

A reminder

If the World Health Organisation is in favour of handing out protective equipment to families and setting up very basic clinics it is now coming round to saying in public what just about anyone pointed out much earlier, as I did on 5th August:

If treatment is really unlikely to help victims, then in a big outbreak it might best to avoid attempts at close contact nursing, and rely on quarantine and subsequent disinfection as the best way to save more lives. Perhaps hydration packs distributed to homes under quarantine would be best, but that is for public health specialists to judge.

So, I have quickly corrected 3 errors, and drawn attention to a prior, modest suggestion for Ebola management.

If you detect any further errors in the way that experts are dealing with Ebola, please let me know of them as they arise, daily.