Most doctors lack experience with Ebola, a disease never diagnosed in a human in the United States until this September.
But, now, with rising concern about stopping the spread of the epidemic beyond West Africa, they must learn – and quickly.
In cities across the country, including Buffalo, measures include training physicians and nurses to identify and initially treat suspected Ebola patients, even though experts say a large outbreak in the U.S. is unlikely.
One example: A standing-room-only crowd of more than 100 doctors, medical residents and students on Thursday watched a detailed “Grand Rounds” presentation on the Buffalo Niagara Medical Campus that was also televised to health personnel at Erie County Medical Center and the Buffalo Veterans Affairs Medical Center.
In another sign of preparations, the state added Erie County Medical Center and Women & Children’s Hospital to the initial list of 10 hospitals that have agreed to serve as Ebola “super centers” to provide longer-term care for patients potentially suffering from the virus.
The state, in conjunction with New York City, also agreed to create a program of financial incentives and other employment protections to encourage health care workers to travel to West Africa to treat Ebola patients and help control the spread of the disease.
So far, nine people have been treated for Ebola in the U.S., and one has died. Cases have reached 13,676 people, with 4,910 deaths, in the three Western African countries – Sierra Leone, Liberia and Guinea – hardest hit by the virus, according to the federal Centers for Disease Control and Prevention.
Drs. John Sellick Jr. and Alan Lesse, both experienced in infectious diseases, discussed “Ebola Virus Disease – NOW Everyone is Interested,” reflecting an attitude in the medical community that, until now, Ebola was a frightening but rare condition that received little attention.
“People had the general feeling that Ebola was a niche disease, something that happened way over there, so why worry about it,” Sellick, epidemiologist at Kaleida Health and the VA Medical Center, said in a separate interview.
No more. The presence of Ebola in the U.S. has generated enormous interest and hysteria, said Lesse, vice chairman for education in the University at Buffalo Department of Medicine.
Lesse and Sellick gave their audience a technical overview of the disease and a handful of key points:
• While acknowledging some missteps, they said a good measure of the changing recommendations for Ebola arises from the fact that doctors and nurses have little or no experience dealing with it.
Physicians are learning how best to treat the virus as the epidemic evolves, and the actions they take will differ somewhat here from in Africa because of differences in culture and health care systems, Lesse said.
“It’s kind of frustrating. If you watch TV, you hear people saying that the experts keep changing their minds. But this is a new disease to us, and we are dealing with a lack of perfect data.”
• The risk of Ebola to the public remains low, but concern is reasonable, especially among health care workers.
The CDC on Monday revised its recommendations for patients with possible Ebola who arrive in hospital emergency rooms. The agency noted it learned lessons from initial experience, such as in Dallas, where the Ebola virus spread to two nurses who had cared for a patient who died.
“Initial triage is the key,” said Sellick. “You have to identify cases before they wander around.”
Because some Ebola symptoms resemble those of the flu, including fever and headache, the guidelines stress that emergency department personnel ask patients if they lived or traveled in a country with widespread Ebola transmission or had contact with a patient with confirmed Ebola in the previous 21 days.
“We are preparing like crazy,” Sellick said. “I hope the virus doesn’t show up on our doorstep. If it does, I believe we can take care of it.”
Outside the hospital in the community, the risk is low for the public, Sellick and Lesse said. They stressed that Ebola is not spread through casual contact and said there is no good evidence of airborne transmission, such as with the flu.
However, if the world is ever to truly get a handle on Ebola, Sellick said, the main effort must focus on eradicating Ebola at its source – in Africa.
• Hospitals must do more than purchase personal protective equipment (PPE) for staff who handle suspected and actual Ebola cases.
“It’s a program, and not just PPE,” said Sellick. “You have to practice. You need a meticulous strategy with a checklist.”
Hospitals here designated as Ebola hubs for treating patients say they are ready.
At Women & Children’s, for instance, several unannounced drills in the Emergency Department were conducted, and more drills are planned for other potential points of patient entry, such as admissions and registration, according to Dr. Steven Turkovich, chief medical officer.
In addition, he said, other measures include posting signs about travel history to West Africa in strategic locations and in eight languages; purchasing personal protective equipment and training staff in its use and removal, and identification of isolation rooms.
ECMC reported that it had taken similar steps.
“If an Ebola patient comes to ECMC, only a small group of clinical staff will interact with them and a patient will be totally isolated from the general patient population,” said Charlene Ludlow, chief safety officer. “We will continue to take every precaution to ensure the safety of every ECMC family member and patient.”
Sellick sees parallels today with the emergence of HIV, the virus that causes AIDS, in the early 1980s. The disease came with a large measure of fear and stigma.
“I started my career in HIV-AIDS, and a lot of the reactions are almost identical. People didn’t want patients in their neighborhood. They didn’t want to touch them. There was talk of quarantine. It was fear of the unknown,” he said.
As people learned more about the disease and physicians became more adept at treating it, he said, fear lessened.