Ebola - Be careful, not paranoid

by Jean Lowrie-Chin | Jamaica Observer column |13 October 2014

Looming even larger than the pesky chikungunya virus is this ebola scare. A friend of mine who went to the Norman Manley Airport to meet a guest from an African country had a three-hour wait, as health authorities carefully questioned and examined the individual. Finally the visitor was cleared and allowed to leave the airport. I find that reassuring – obviously the Health Ministry is working to ensure that the island’s gateways are well screened.  

It is interesting that we did not see this widespread international frenzy about ebola until the disease arrived in the North, with the death of Thomas Eric Duncan in Texas last Wednesday and the frightening diagnosis of nurse’s aide Teresa Romero in Madrid. 

Yet, four days before Thomas Duncan arrived in the US, and more than a week before he was sent home undiagnosed with antibiotics from the Texas Presbyterian Hospital in Dallas, Texas, Reuters reported on September 16, “President Barack Obama on Tuesday called West Africa's deadly Ebola outbreak a looming threat to global security and announced a major expansion of the U.S. role in trying to halt its spread, including deployment of 3,000 troops to the region.”

The report quoted the President further, as he spoke at the Atlanta headquarters of the U.S. Centers for Disease Control and Prevention (CDC): "The reality is that this epidemic is going to get worse before it gets better. But, right now, the world still has an opportunity to save countless lives. Right now, the world has the responsibility to act, to step up and to do more. The United States of America intends to do more.”

Did the President’s race affect the way his message was received by other world leaders? We hope not, but what we do know is that even as the brave Médecins Sans Frontières (MSF) representatives were appealing to the international community, help was slow in coming.  According to reporter for PBS Frontline Priyanka Boghani, “Doctors Without Borders, or Médecins Sans Frontières as it is known internationally, began its Ebola intervention in March 2014, and now runs five Ebola management centers in the affected countries.” In her interview Dr Estrella Lasry, a tropical medicine adviser at MSF, we understand how contagious this disease can be.  

Dr Lasry explained: “If you’re going to do a rumor check or assess a suspected case in a village, what we do is we don’t talk to the patient straight in front of them. We’re at more or less arm’s-length, talking to the side of the patient because of the risk of contagion by droplet. And we have gloves if we’re going to touch the patient, otherwise no. At this point we’re not using masks, unless we know that a patient is coughing a lot or vomiting.

“When we’re in the triage area in either Ebola facilities or non-Ebola facilities, it varies a little bit, but we’re wearing scrubs, rubber boots, gloves, a mask and goggles most of the time to protect all of the mucuses.

“When we go into the [isolation] ward, we’re wearing full personal protective equipment, which means a Tyvek hazmat suit with a hood on top of it. The suit has a hood that comes with it, but we use another hood that covers the full head, the face, and has a mask, but we wear a mask underneath that as well. And then we have goggles on top of that, double or triple gloves, and boots, and an apron on top of that.”

When the Australian government offered MSF US$2.5 million towards their efforts, they refused the money because what they needed were people to assist them with their labour intensive work.  One woman who survived ebola described the long wait for the dead to be taken from her ward as it takes four persons to do the exercise safely.  When someone has to remove protective gear, it requires another person to assist as a simple slip can cause infection. There are ebola boot camps now in operation around the world where soldiers and civilians are being trained in these procedures.  Hopefully, that is happening here in Jamaica too.

No wonder then that all of us at our office were dishing out advice to a colleague about to go on holiday in New York. As we gave him detailed instructions about handkerchiefs and hand-sanitizers, we saw he was getting a bit unnerved, so we reassured him: don’t be paranoid – just be careful and enjoy your holiday.