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Why people are still getting infected with Ebola virus even after taking precautions

Yes, several worried people are asking me this question.

People, especially health care workers are taking precautions alright. But are they full proof? No, is the affirmative answer given by the experts.

First of all a person who is about to come in contact with an isolated patient infected with the virus should have full picture, I insist on this aspect over and over again, otherwise he or she might get infected too. Full scale training will stop the spread of the disease. But nurses, who never dealt with such cases before and don't have full training, are highly vulnerable because they treat Ebola cases like any other disease!

We know that Ebola spreads through infected body fluids. Therefore the healthcare workers and people who dispose the dead bodies should wear protective gear. And they should follow the rules fully, I repeat, fully without leaving a single thing. You can read here and here how this should be done.

Workers going into isolation units should, at a minimum, wear gloves, goggles or a face shield, a gown and a mask or respirator. These are called personal protective equipment (PPE) and are different from full hazmat suits seen in some images from Ebola cleanup programs in Africa. But simply covering up is not enough to prevent spread of the virus. In addition to ensuring that no skin is exposed, health care workers must exercise extreme caution while with the isolated patient—to avoid needle pricks and other accidental routes of contamination. And perhaps the most challenging link in the chain is the exiting procedure. After leaving the isolation area a healthcare worker must be fastidious in properly removing each potentially contaminated item safely. The potential to expose for these workers is real. The suiting-up process and proper equipment removal can be very difficult.

The procedure has two prescribed methods (pdf) for safely removing protective equipment. Each tactic involves at least 10 distinct steps—from removing gowns from the inside out (starting with neck and shoulders) to which ties on a mask to grab first (the bottom)—and admonitions to wash hands immediately if they accidentally come into contact with the exterior of any piece of gear. "Doing this right 100 percent of the time does require very intensive training, follow-up [and] monitoring, according to experts. The procedure is extremely difficult to master.

Moreover, invasive procedures like dialysis performed to clean the blood, respiratory intubation in which a tube is inserted into the throat, might expose the health care workers to the body fluids of the patients. Therefore these procedures are sometimes temporarily stopped too to protect health care workers and doctors from getting infected. Also, to minimize risks, specialists in Europe designed treatment centers that are precisely laid out: with single entry and exit points, strict separation of high risk and low risk areas, and space for health workers in a buddy system to watch over one another while removing contaminated protective gear. When a volunteer French nurse became sick last month, they resolved to make the safeguards tough. Aid organizations occasionally grumble about cockiness among Doctors Without Borders workers (M.S.F.), who are on the front line in African infected areas, safety protocols because they are so rigorous they can seem like overkill and a focus on immediate help that does little to buttress local health systems over the long term. But these are strictly necessary to stop spread of the disease. MSF doctors are very courageous and are helping the African countries. These people need to be protected and their lives should be saved at all costs because without the work of these selfless doctors, Africa would have been in much more worse situation than it is now. It already started efforts to contain the disease. And if you don't follow their rules strictly and efficiently you will be doomed as a health care worker.

And in regions of the world the disease hasn't been reported till now...

Hospitals are expected to follow a protocol when they suspect a person of having contracted Ebola. When a patient has symptoms of the virus like high fever, intense weakness, muscle pain, sore throat, vomiting, diarrhoea and generalized rash, the doctor must ask his/her recent travel history. Travel to any of the hit West African nations or contact with people who've been to any of those countries recently needs to be tested. Only an oral paracetamol is to be given to the patient. Care should be taken to not inject the patient with anything. Any kind of prick may risk the hospital's safety especially when it is not equipped to deal with Ebola.

There are several reumers that are being spread on the internet. These must be treated with a pinch of salt. The Ebola viruses buffeting West Africa today are not fundamentally different from those in previous outbreaks, the experts say. And it is highly unlikely that natural selection will give the viruses the ability to spread more easily, particularly by becoming airborne.
'We have been dismayed by some of the nonsense speculation out there', say biologists. They understand why people get nervous about this, but as scientists, they say, they need to be very careful and don't scaremonger. They say, be careful and vigilant, not hysterical and vigilant.

Ebola spread now shows flaws in protective gear and procedures followed. The nurse at Madrid’s Carlos III Hospital who became the first person outside west Africa to contract Ebola, told media outlets in Spain that she may have accidentally touched her face with one of her gloved hands while she was removing her protective gear. One doctor attending to the nurse wrote a letter to his superiors pointing out that the sleeves of his protective suite were too short! These have to be corrected. Proper training and equipment as well as an abundance of caution are necessary, given the lack of experience health care and cleanup workers have in dealing with Ebola. Cleanup workers will have to wear three layers of gloves to protect themselves while working but also have to safely undress after the work was done. That way, one can undress in layers, keeping one's hands protected as one removes layers of possibly contaminated clothing.

Nigeria has been declared Ebola-free now. And what are the reasons of its success?

  • Fast and thorough tracing of all potential contacts
  • Ongoing monitoring of all of these contacts
  • Rapid isolation of potentially infectious contacts

The swift battle was won not only with vigilant disinfecting, port-of-entry screening and rapid isolation but also with boot leather and lots and lots of in-person follow-up visits, completing 18,500 of them to find any new cases of Ebola among a total of 989 identified contacts.

Such ground-level work may sound extreme, and the usually measured WHO declared the feat "a piece of world-class epidemiological detective work."


The conventional wisdom is that Ebola is unlikely to spread like, say, influenza has in the past, because it’s hard to catch. The Ebola virus is not airborne. You have to come into actual contact with a sufferer’s bodily fluids – blood, saliva or semen – in order to catch Ebola (the World Health Organization says it hasn’t been found in sweat).

Why then are so many health workers contracting Ebola when it is supposedly so “hard to catch”? There are three possible explanations:

  1. Lapses in infection control protocols, such as mistakes when putting protective equipment on or taking it off.
  2. Inadequate guidelines that are failing to protect against other (non-contact) modes of transmission.
  3. Health workers are becoming infected somewhere other than where they’re in direct patient contact (where they do not expect to be at risk). This is possible in West Africa with such a large scale epidemic, but is unlikely in the United States and Spain.

In most cases, lack of knowledge about infection control may not be critical, but in the case of Ebola it may cost lives. If even some people learn something about the disease which enhances their occupational health and safety, then we would have provided something useful for people involved in the response.

So, why caretakers are still catching Ebola? The answer seems to lie in a fatal combination of proximity, ignorance and fecklessness.  Every little movement has to be done right and you have to know what to do while dealing with Ebola patients. Caretakers are making mistakes while following the procedures, pure and simple.

To avoid infection, health care workers should get trained fully, follow instructions carefully, should have tremendous patience, have to be strict with themselves as well as with their colleagues. In the hard world of highly infectious diseases, your win over the virus is directly proportional to your full knowledge and the resolve to fight it with all your might. This is a war with a highly dangerous enemy. If your efforts are even 0.001 less than the required strength, you are doomed. Period.

Views: 202

Replies to This Discussion

http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf

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How Did Nigeria Quash Its Ebola Outbreak So Quickly?

What we can learn from the boot leather, organization and quick response times that stopped Ebola from spreading in this African nation
http://www.scientificamerican.com/article/how-did-nigeria-quash-its...
Becoming Ebola Ready:
http://www.scientificamerican.com/article/what-makes-a-hospital-ebo...
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Many Mysteries Still Surround Ebola

The virus that causes Ebola is well understood but puzzling issues remain on topics such as the disease's lethality and whether the virus can be stopped
http://www.scientificamerican.com/article/many-mysteries-still-surr...

The Ebola questions

Scientists know a lot about the virus that causes Ebola — but there are many puzzles that they have yet to solve.

http://www.nature.com/news/the-ebola-questions-1.16243

Maine Nurse Defies State Ebola Quarantine, Leaves Home
A nurse in Maine has vowed not to be bullied by politicians and is threatening to sue the state over an Ebola quarantine she calls unscientifically sound - according to Reuters.
Who is she to decide? When in doubt, it is better to play safe than sorry.
But still I think some people are getting panicky and are going to the extremes. Recently some researchers and medical personnel who just returned from Africa were banned from a medical conference in the US!
I think both these things are extreme behaviours! If people of science behave like this, who can 'control' common peoples' fears?

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Side effects vex anti-malaria push in Sierra Leone

Mass drug distribution intended to reduce cases with Ebola-like symptoms.

http://www.nature.com/news/side-effects-vex-anti-malaria-push-in-si...

People hired by the government of  Sierra Leone to track down people who show symptoms of Ebola and deliver them to medical caret say that most of the health complaints they have heard lately can be traced to the side effects of a malaria drug. “People are vomiting and tired,” he says. “Two of them couldn’t even stand up.”

In early December, public-health workers distributed malaria medication to 2.52 million people in Sierra Leone. The effort was meant to curb the number of malaria cases as the disease approaches its peak season, and reduce, in turn, the number of people whose symptoms could be mistaken for those of Ebola. The government is planning another mass distribution in mid-January.

People's reluctance to take the malaria drug increases the likelihood of that very problem. Because malarial fevers are similar to Ebola fevers, anyone with a fever is told to check into a clinic to be tested. There, people with malaria wait hours or days for diagnosis beside others who may have Ebola. And fear of contracting the virus seems to have kept malaria patients from seeking treatment: in August 2014, the number of children diagnosed with the parasite was half what it was in the same month of 2013.

But the side effects of the drugs can limit the efficacy of this approach, known as mass drug administration (MDA). People report fatigue and nausea — side effects that can be intensified if they have taken too many pills at once or have taken the drugs on an empty stomach. As word has got around about these problems, some people have opted not to take the medicine as directed, or at all.

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