Saturday, August 2, 2014

Bringing Ebola Patients To The U.S.- Not A Very Good Idea!

Researcher working with Ebola using a BSL-4 positive pressure suit

"The road to hell is paved with good intentions"- John Ray, 1670

Murphy's Laws:

1)  "If anything can go wrong it will"

2)  "If there is a possibility of several things going wrong, the one that will cause the most damage will be the one to go wrong"

3) "If anything just cannot go wrong, it will anyway."

4) "If you perceive that there are four possible ways in which something can go wrong, and circumvent these, then a fifth way, unprepared for, will promptly develop"

5)  "If everything seems to be going well, you have obviously overlooked something."

6) "Mother nature is a bitch". (Addendum: "And not an obedient one at that")

At this stage, with one of the Samaritan Purse workers (Dr. Kent Brantly) infected with Ebola en route to the U.S. and Emory University Medical Center's Isolation Ward in Atlanta, one must wonder about the wisdom of the move - as well as that of the 2nd worker (Nancy Writebol), also being flown in via medevac in the subsequent flight.

In general, it is not a good practice to transfer patients infected with one of the most lethal viruses on the planet into a non-infected nation. This is different, materially and substantively, from keeping the virus in a Level 4 containment lab in one of the most secure places on Earth (ok, at least we thought so until cardboard boxes containing Variola (smallpox), Anthrax and a lethal Bird flu were discovered).  In the case of the latter, the actual contact with the virus can at least be controlled - and more importantly  - the risks of contamination don't extend to having to add many more protocols to confine the spread of the contaminated fluids spewed out of actual bodies. Workers need only control their contact with the actual isolated virus and not with the infectious diarrhea, vomit, sweat or blood spewed out.

Hence, there is much greater probability of things going wrong when stringent added protocols are incorporated -  to protect against Ebola-laden fluids - and there is, literally, no margin for error.  Murphy's Laws, which many take only in a facetious or non-serious vein, are actually apropos here. They really do provide a mental caution against adopting hubris or projecting human arrogance, especially the ever present human failing embodied in the misplaced belief that all their systems are "perfect" and "nothing can go wrong."  ("We have it all under control." - perhaps the sorriest words ever written or said.)

Actually, many things can. The transport to Emory itself means a 20 mile trip along a highway to get to the Emory center. Though a police escort is to be provided, the possibility of some kind of accident still exists. But we can concede this is relatively low.

Move now to the Emory Isolation ward itself which will keep each patient separate from the rest of the hospital and with an air-filtered space to boot. Two specially trained nurses will tend to each patient and 4 infectious disease specialist doctors. However, there is no indication whatsoever that any of these Emory people have had previous experience in handling Ebola patients. That implies they will not be as careful as say, a 'Doctors without Borders' specialist in Sierra Leone, who knows every single pitfall and goes the extra mile to avoid human error.

Again, these specialists won't be working with the virus per se but rather treating two symptomatic patients expelling contaminated body products. We can expect as the two patients are attended to, they will still be in the phase of vomiting, diarrhea as well as hemorrhagic release from multiple orifices, so that the slightest drop of any fluid on a pressure suit or even its duct tape will be an alert or alarm point. How will the nurses, doctors deal with it? How intensely will they clean themselves after being in contact with the patients? How sure are they that there are no minute holes in their suits? How will any contaminated clothing, bedding be handled? Even if the doctors themselves work on the patients from outside using robotic type devices, someone will have to go in, collect the fouled bedding, clothing and dispose of it.

It is in the handling and disposal of those contaminants that the real risk inheres and Murphys' laws come to the fore.  While it is true Ebola is "not contagious like the flu" (so far as we know) it is still quite capable of penetrating medical barriers erected against it, as Dr. Brantly found out. Hence, one must exercise constant and meticulous care if error is to be avoided. It only takes one misstep!

This is especially important given we live in a country which already sees something like 98,000 deaths by medical accident or  hospital infection each year. In the case of the latter, most of those deaths  - say from c. diff. or MRSA - could have been easily prevented if proper disinfectant techniques had been observed. But they weren't.

 Many people forget that, especially those who demand we show "compassion" to the two aid workers. (Forgetting that the needs of the few or the one do not exceed the needs of the many.) Well, we do, but also suggest that reasonable compassion can't mean putting many thousands or millions at possible risk, or compassion at any price.

Maybe the Emory specialists and CDC honchos are correct that there's nothing at all to worry about and nothing will go wrong. But having seen a number of Murphy's laws in action in other settings I am not so sure. I definitely lack the hubris or overt self -assurance detected in the words I've beheld uttered by one of the Emory docs who will be treating the patients. ("We know what we have to do and we're confident!")

We've been given all the reasons this move is a great idea, including that the patients can now receive the best of care (of which I have no doubt) and also the protocols are in place to ensure maximum safety (of which I am unsure). We also have been told the protocols in Africa are too difficult to follow because of the lack of supplies, etc. However, I dispute that given the disease has been in the spotlight and studied since 1976, and some of the best specialists have been there to treat and tend to the disease in its actual environs. They have also flown in all the equipment they might need, to specific locations. Yes, the Emory site does afford some extra advantages (more easily controlled temperature environment, more backups) but again, are the risks worth it?

Only time will tell, and if one of Murphy's laws is violated and an outbreak of Ebola occurs in Atlanta, we have to hope it is expeditiously contained and doesn't spread. Bill Maher, as on Real Time last night, may mock "morons" for expressing their fears about the situation and its potential unraveling - but alas, those fears aren't warrantless, they're quite real.  Alas, the real morons will be those who proclaim- in the aftermath of other possible cases in the area weeks later:   "We never knew it could happen!  We thought we'd done everything humanly possible to prevent it!"  

Read each of Murphy's laws again, then think about them. Carefully! Especially the last, recognizing that already in Africa , Ebola is manifesting 'Mother Nature's' fury at its most extreme and is spinning out of control - exceeding all medical efforts to contain it. Then ask if it is truly a good idea, irrespective of any "humanitarian" aspirations, to have brought it to our shores. 

Will our good intentions possibly have visited "hell" upon us? We will see.

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