Ebola prompts extraordinary precautions

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In Nigeria
Aug 15th, 2014
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From Nigeria to the United States and many other parts of the world, the fear of the spread of the Ebola Virus ravaging West Africa has led to extraordinary precautionary measures, writes Wall Street Journal

The  Ebola outbreak in West Africa has prompted hospitals and health authorities in other countries to take precautions that often go beyond experts’ recommendations, showing the impact of public concern about the deadly disease.

Health officials in Charlotte, N.C., are taking no chances with three missionaries who returned to the U.S. earlier this week from Liberia. All had contact with patients sick with Ebola. So even though they are healthy, the three have been quarantined on the campus of the religious organisation for which they work.

Quarantining people who were exposed to Ebola but don’t have symptoms is unusual. But their employer and the public health department say they want to go the extra mile. “We want to be overly cautious,” said Stephen Keener, medical director of the Mecklenburg County Health Department, which issued a quarantine order for the missionaries.

The measure was taken “so the public can be reassured of how we’re handling this,” said Bruce Johnson, president of SIM USA, the organisation for which the missionaries work. The three-two doctors and the husband of one of the infected Americans evacuated earlier to the U.S.-have been quarantined for 21 days from their most recent exposure, the maximum incubation period for the virus.

The three are staying in recreational vehicles on a 90-acre campus with other missionaries and children who also were in Liberia but not exposed to Ebola, he said.

Only a few Ebola victims will have access to an experimental treatment that was effective in treating monkeys with the virus. What other options are there for halting Ebola from spreading, and for treating those already infected? WSJ’s Jason Bellini has #TheShortAnswer.

Health authorities and doctors elsewhere are going to lengths to prevent the world’s largest outbreak of Ebola from spreading. Some are exceeding measures recommended by agencies such as the Centers for Disease Control and Prevention. Others are taking precautions used for diseases that are highly contagious because they spread through the air, while Ebola spreads only through contact with bodily fluids of an infected person.

But they say the deadly nature of Ebola, which has killed 54% of those infected in the current outbreak and up to 90% in other outbreaks, and concerns from the public justify the precautions. Reports of possible cases from New York City to Hong Kong have alarmed some in the public, though fears subsided somewhat after all tested negative.

“Ebola has a higher mortality rate among those infected and it’s very important that all exposures are prevented,” said David Kuhar, a medical officer leading the health-care infection control team for the Ebola response at the CDC.

 Some airlines have suspended flights to Guinea, Sierra Leone and Liberia, three of the affected nations. Sales of face masks have exploded in West Africa, and immigration officers in Nigeria, Ghana and Liberia are wearing them. Zambia banned entry to citizens from the four affected West African nations, including Nigeria.

Current CDC guidelines call for people who are at high risk of exposure to Ebola, but who don’t have symptoms, to take their temperatures twice daily for 21 days, avoid long-distance travel, consult with health authorities on local travel and symptoms, and stay close to a hospital that can treat Ebola in case they develop symptoms.

The special isolation unit at Emory University Hospital in Atlanta where two infected Americans are being treated was designed for patients with diseases more contagious than Ebola, such as SARS. While technically they could be treated in any hospital capable of isolating a patient in a single room, the Emory facility has staff specially trained in infection control and an ambulance equipped to transport infectious patients.

Given the high-profile nature of the cases and the high death rate of Ebola, “it’s reassuring and instills some confidence,” said Alex Isakov, an emergency medicine physician at Emory.

In New York City, Mount Sinai Hospital health staff wore respirators and hood-like devices on their heads, in addition to standard gear recommended by the CDC, when they treated a man last week who was suspected of having Ebola but released after testing negative for the disease.

Standard CDC guidelines call for hospital staff to wear gowns, gloves, face masks and eye protection. That is all that is routinely needed for treating single patients in an isolation unit in a U.S. hospital, as compared to an Ebola treatment center in Africa full of very ill patients, infection- control experts say. But CDC guidelines also say that additional protective clothing or respirators can be used in certain situations, such if a patient needs to be intubated, to prevent infection.

The measures are “not strictly necessary, but we allowed them for the comfort of the staff,” said David Reich, Mount Sinai’s president. Staff had seen pictures of health workers in Africa and at Emory wearing full gear, including the hoods, he said.

“It doesn’t hurt to be cautious,” he said. The hospital, like others in the U.S., is taking careful travel histories from patients to quickly identify and isolate potential Ebola patients.

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