Nurse who treated Dallas Ebola patient is infected

by Unknown 11:12 0 comments Health Wise Science

First case of transmission within the US.

CDC Director Thomas Frieden, MD, MPH, confirmed this morning on CBS News’ Face the Nation that a Texas Health Presbyterian Hospital caregiver has contracted Ebola virus disease while caring for Thomas Eric Duncan.

Duncan, a Liberian man who contracted the disease before traveling to Texas to join his family and marry his longtime girlfriend, died at the hospital on October 8.
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease told Chuck Todd on NBC News’ Meet the Press that there was clearly “an inadvertent breach of protocol” that led to the health worker being infected.
While he says that we don’t know the details of the breach, Dr. Fauci mentioned that removing personal protective equipment after a long shift has sometimes been associated with the infection of health care workers.
Waving his hand across his face, Fauci explained that all it might take for a health care worker to be infected would be to make contact with the outside of their protective wear on the way to touching their face.
Infectious diseases journalist Maryn McKenna also wrote on Twitter this morning that the Spanish nurse’s aide who contracted Ebola did so while taking off her protective wear.
Fauci said that the CDC is currently investigating the precise breakdown in protocol. Rebecca Kaplan at Face the Nation wrote:

“Frieden said the CDC is taking four steps going forward: making sure the worker is cared for safely and effectively; identifying the worker’s contacts; treating all health care workers who cared for Duncan as having potentially been exposed; and conducting a full investigation of the procedures in place to protect health care workers who treat Ebola patients.”

Chuck Todd raised the point with Dr. Fauci that while U.S. health officials have been aggressively reassuring Americans that the risk of an outbreak here is zero, infection of this nurse might confirm some worst fears. In response, Fauci said that we shouldn’t conflate infection of a clinician in repeated, direct contact with a patient with a broad outbreak.
I, too, shared this optimism on the evening that Mr. Duncan’s Ebola diagnosis was released. But that optimism was already being tempered by that of physicians like Judy Stone, MD, a physician and writer who has practiced in infectious diseases and infection control for over 30 years.
On her Scientific American blog, Dr. Stone, wrote a week ago,

“While I agree that we have the knowledge, experience, and resources to be able to control Ebola, most of the experts are academicians or practice in relatively well-heeled ivory towers.”

She cited the disconnect between administrators and practitioners on the front line of patient care and the focus on dazzling new tools and techniques rather than the less-glamorous training exercises to test whether basic infection control measures are working under routine conditions.
Laurie Garrett, Pulitzer Prize-winning journalist and current senior fellow for global health at the Council on Foreign Relations, wrote in The Washington Post on October 11 that,

“Hubris is the greatest danger in wealthy countries — a sort of smug assumption that advanced technologies and emergency-preparedness plans guarantee that Ebola and other germs will not spread.”

Dr. Stone also makes note of the need to separate politics from the funding of public health and research. She documents that CDC public health and preparedness funding was cut by $1 billion between 2012 and 2013 and their discretionary funding cut by another $585 million between 2010 and 2014. Funding for research through the National Institutes of Health (NIH) was cut by $446 million during this same time period.
In her discussion of our developed-world hubris, Garrett echoed Stone’s comments,

“And it is hubris that causes politicians to routinely slash public health budgets every time the microbes seem under control, only to cry out in desperation when a new epidemic appears.”

Closing her article last week, Dr. Stone summed up her feelings:
“At this rate, what is happening in Dallas is going to be about as effective as the shameful response to Hurricane Katrina was,” wrote Stone.
The hope now is that the “inadvertent breach of protocol” in Dallas was just that, and not a systemic problem. But CDC’s Frieden is already saying that it would not be unusual for us to learn in coming days that other health care workers might have been infected due to the same breach.