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Chris Christie and Andrew Cuomo recently decided to quarantine medical workers who have come in contact with Ebola, despite many doctors and health experts telling them that their strategy is dumb. Ted Cruz and Rick Perry have also advocated for more fear-based isolation strategies. Doctors keep stressing calm, and explaining that American medical workers need to be able to travel to and from places like Liberia freely in order to fight the epidemic, and politicians keep itching to start quarantining everyone who has ever coughed.
Still, holding centers and isolation zones are are a fact of life in places like Liberia, and they need to be used carefully and correctly. I talked to Dr. Susan McLellan, a professor of both clinical and tropical medicine at Tulane University’s School of Medicine, who has also worked extensively in both Haiti and Rwanda. She told me what deceptively simple but effective things can be done, and why those things aren’t so simple in developing parts of Africa. She also told me about how fear can make everything worse.
VICE: What can holding centers in developing parts of the world can do to help stop the spread of infectious diseases?
Dr. Susan McLellan: In less developed parts of the world, it’s particularly difficult because copious running water, paper towels, and things like that are not necessarily easily available, so that makes a real difference. What places that are establishing treatment units are trying to set up is availability of heavily chlorinated water for cleaning as well as lots of personal protective equipment, and that ends up being the basics, as well as a way to feed people who are being admitted.
Are the Centers for Disease Control's new guidelines about medical workers not exposing skin around Ebola patients necessary?
A great deal of misinformation continues to be spread about the level of protection required. The science tells us that this is a disease that is spread by contact with infectious bodily fluids, not through the air air or by skin that is exposed to the air around an Ebola patient. I know from personal experience that one can take care of many Ebola patients with skin exposed and not become infected.
Why'd they change it?
There’s two reasons. One is the level of care that may be offered in United States institutions may include more procedures, which could potentially result in some kind of “spray”, which could reach exposed skin. Now, we don’t think the virus typically gets in through exposed skin, but any contamination on exposed skin increases the risk that one could transfer that contamination to one’s eyes or mouth.
And the other reason?
A simple acknowledgement that fear trumps science. Because of a great deal of fear, individuals in situations where the bare minimum personal equipment was provided felt necessary to add on to it in ways that may not have been safe or may not have allowed for safe removal (of the equipment).
Extra layers of gloves or things that are taped on are difficult to remove in a controlled and careful fashion. In that sense the risk of contamination may be [increased]. The more layers one puts on the more there is a chance for exhaustion, which leads to the inability to move in a controlled and careful fashion. And that puts not only the health-care worker but also the patient at risk.
Why has Ebola been so efficient in spreading throughout Africa?
This is a disease that is spread between human beings because human beings care for one another when they’re sick. In Sub-Saharan Africa, families care for their families in the home until they are extremely ill or until death, as opposed to bringing them in at the first sign of fever. That is for a multitude of reasons, including the fact that health-care facilities are not that good to start with, and they (families) have to pay for it and that may break them for a long time. They also may not be able to access a health-care facility easily or they may mistrust the health-care providers – all kinds of reasons.
So a disease that is spread by close contact of bodily fluids – and which produces manifestations of vomit and diarrhea and production of a lot of unpleasant fluids – can be easily spread by the kind of care that is done in the household.
I should reiterate that these are households, usually, which do not have running water, electricity, paper towels, and flush toilets. The likelihood that infectious materials will get on somebody’s skin and be there for a long time is hugely greater than in even the poorest households in the United States. In West Africa there is a very dense population, and these three countries are in the lowest on the Human Development Index.
Is it just poverty, or is there anything else making it hard to fight Ebola in the region?
They have been ravaged by years of civil war, and are barely coming out of that, and they have a history of not entirely ethical governments. They also do not have well-established healthcare infrastructure to respond to any health threat, including the ones that existed in the past. With the density of population, also comes the fact that there are wonderful roads in that area, making transportation easy. And that has all combined to make this a spectacularly successful epidemic from the side of the virus.
Are US hospitals properly equipped to deal with some of the more granular details in regards to infectious disease protocol?
Hospitals’ levels of preparedness are, of course, varying. I think we’re all a lot further along now, having had our unfortunate sentinel chicken get hit in Dallas. That really brought it to many peoples’ attention that, in fact, somebody could walk into any hospital and that mistakes can easily be made if people don’t have a plan and are not prepared. I think preparation is much further along now.
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