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Defenses inadequate for U.S. nurses treating Ebola

The Eye of the global Ebola storm is now fixed on two Dallas nurses who came down with the viral hemorrahgic fever after treating Liberian citizen Thomas Duncan. Duncan developed symptoms on returning to Texas from a trip to Liberia in September. He died Oct. 8 while receiving treatment at Texas Presbyterian Health Hospital.

One of the infected nurses, 26-year-old nurse Nina Pham, appears to be recovering; the other, Amber Vinson, began showing Ebola symptoms on Tuesday, the day after she’d taken commercial flights from Dallas to Cleveland and back. It’s further alarming that Vinson had notified the Centers for Disease Control before the flights that she had a low-grade fever — and the CDC let her fly, anyway.

CDC Director Tom Frieden seemed almost nonchalant about the development.

“Although she (Vinson) did not report any symptoms and she did not meet the fever threshold of 100.4, she did report at that time she took her temperature and found it to be 99.5,” Frieden said Wednesday. He admitted that Vinson’s temperature, coupled with the fact she had been exposed to the virus, should have prevented her from getting on the plane — in other words, his government agency screwed up by letting her fly. But Frieden added, “I don’t think that changes the level of risk of people around her. She did not vomit, she was not bleeding, so the level of risk of people around her would be extremely low.”

It’s dumbfounding that the CDC director continues speaking in terms of low risk when the public increasingly demands to know why we’re expected to tolerate any risk at all.

More than two months ago, when American health care workers Dr. Kent Brantley and Nancy Writebol became infected with Ebola in Liberia, and the decision was made to return them to the United States for treatment, a Butler Eagle editorial questioned the wisdom of that decision and argued it’s safer to combat Ebola at its source than to bring it here voluntarily. We concurred with contagious disease experts that the risk of a U.S. outbreak was very slight, but questioned why any risk was acceptable when that risk was avoidable.

“It is true the risk of spreading Ebola in the U.S. is minimal. Allowing Writebol and Brantley into the United States presents at worst a remote risk,” reads the Aug. 7 Eagle editorial. “But the question must be asked: Is any risk necessary? Must we flirt, if even slightly, with a health disaster?

The question was intended as rhetorical, but the ensuing circumstance — the beginnings of an Ebola outbreak on American soil — turned out to be disconcertingly prophetic.

The infection of two trained nurses increases public awareness of the dangers health care workers face while doing their jobs; but it also begs the question whether the medical community is adequately prepared to protect itself — and us — from the viral menace.

National Nurses United, the nation’s largest nurses’ union, issued a statement Tuesday saying a vast number of its members are poorly prepared and equipped to defend themselves from the virus.

The union surveyed 1,900 nurses in more than 750 hospitals in 46 states. Thirty-six percent said their hospitals do not have sufficient supplies, such as face shields and fluid-resistant gowns, to care for an Ebola patient; 76 percent said their hospitals have not issued adequate policies.

Bonnie Castillo, a NNU spokeswoman, said most of the nurses surveyed have received only single pages of information about Ebola that refer them to an Internet website.

“That is woefully insufficient,” Castillo said. “We have to continue to sound the alarm. There is the potential for many more Dallases if hospitals are not mandated and do not commit to more vigorous standards. We see potential gaping holes for this to spread.”

Responding to questions about altering CDC’s Ebola policy, NNU officials reply that there is no CDC policy to alter.

Nurses have a reputation for practicality — they would not sound the alarm or risk creating a panic if they didn’t think the alarm was necessary. And they are sounding the alarm. In their professional opinion, the alarm is necessary.

Meanwhile, Ebola has jumped a gap. All 19 previous Ebola outbreaks died out for lack of host humans to transmit the virus in unpopulated rural areas. But now it’s in urban neighborhoods, where there’s no lack of people — and the more people mingle, the more quickly and widely the virus can spread.

Writing for the New York Times, Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, warns that the current outbreak’s patients and deaths outnumber all 19 previous outbreaks combined. And, for the first time, there’s a distinct possibility for an Ebola carrier like Duncan to board a commercial airliner and take the virus to other urban areas.

As a logical consideration, quarantine seems to suggest itself. The CDC and WHO should immediately recommend a ban on travel to and from countries where the outbreak is happening. The officials also must redouble efforts to provide better training and protective gear for nurses and other health care professionals.

The risk of transmission may be as slight as they insist. But they need to take that risk more seriously.

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