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Outbreak On Trial: Who’s To Blame For Bringing Disease Into A Country?

Francina Devariste, 3 years old, is one victim of an ongoing cholera outbreak in Haiti that has killed 8,000 people and sickened over 700,000. (2010 photo courtesy of the United Nations)

Francina Devariste, 3 years old, is one victim of an ongoing cholera outbreak in Haiti that has killed 8,000 people and sickened over 700,000. (2010 photo courtesy of the United Nations)

By Richard Knox

If an international agency introduces a devastating disease to a country, should it be held accountable?

That’s the big question at the heart of a court proceeding that gets underway next Thursday. The international agency is the United Nations. The disease is cholera. And the nation is Haiti.

Four years ago this month, thousands of Haitians downstream from a U.N. peacekeeping encampment began falling ill and dying from cholera, a disease not previously seen in Haiti for at least a century.

Since then cholera has sickened one in every 14 Haitians — more than 700,000 people; and over 8,000 have died. That’s nearly twice the official death count from Ebola in West Africa thus far.

A year ago, a Boston-based human rights group sued the U.N. for bringing cholera to Haiti through infected peacekeeping troops from Nepal, where the disease was circulating at the time. The U.N. camp spilled its sewage directly into a tributary of Haiti’s largest river.

There’s little doubt that the U.N. peacekeepers brought the cholera germ to Haiti. Nor is there argument over the poor sanitary conditions at the U.N. camp.

When I visited the scene in 2012, it was plain how untreated sewage from the camp could easily contaminate the Meille River that runs alongside before it spills into the Artibonite — Haiti’s Mississippi — which provides water for drinking, washing and irrigation for a substantial fraction of the country’s population.

The smoking gun, scientifically, is a molecular analysis of the Haitian cholera bug compared to the Nepalese strain from the same time period. It showed the two differ in only one out of 4 million genetic elements.

“That’s considered an exact match, that they’re the same strain of cholera,” Tufts University environmental engineer Daniele Lantagne told me last year. Continue reading

Mass. Lawmakers Hear Calls For Ebola Training

As nurses raised alarms that they are untrained and ill equipped to handle cases of Ebola virus, Massachusetts hospital officials said Thursday that the health crisis emerging from West Africa demands a unique response.

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

At a Public Health Committee hearing, Massachusetts General Hospital Emergency Preparedness Chief Dr. Paul Biddinger said handling cases of Ebola is “fundamentally different” than regular medical care, and suggested hospitals should create a “highly trained expert cadre” to handle Ebola rather than attempting to train all staff equally.

Massachusetts has not had a confirmed case of the deadly disease, though there have been suspect cases and two nurses at a Texas hospital have been infected with the disease. Ebola is spread from the fluids of a person who is infected and symptomatic.

Massachusetts Nurses Association President Donna Kelly Williams said the training and equipment at Massachusetts hospitals is “inconsistent,” and nurses have said they have been provided with “flimsy” garments that Williams said would not adequately protect them against infection.

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‘Ether Dome': The Story Of Numbing And Inflicting Pain

Greg Balla, Lee Sellars (seated), Tom Patterson and Richmond Hoxie act in a scene from "Ether Dome." (Courtesy T. Charles Erickson/Huntington Theatre)

Greg Balla, Lee Sellars (seated), Tom Patterson and Richmond Hoxie act in a scene from “Ether Dome.” (Courtesy T. Charles Erickson/Huntington Theatre)

On Oct. 16, 1846, a flustered young man named William Morton raced up marble steps to the dome of Massachusetts General Hospital.

“He was late, and you don’t want to keep surgeons waiting,” said Dr. John Herman, a psychiatrist at Mass General who is steeped in the history of that day.

A group of physicians awaited Morton in the operating room, located high above other floors because “before ether, people screamed,” Herman said.

Morton, a dentist, had promised to put an end to those screams, to the pain patients endured during surgery.

That day, with a patient waiting, Morton pulled out a glass bottle of ether that he had colored red, according to Herman, to disguise the common gas. Morton told the patient to inhale. Moments later, a surgeon sliced into the neck of a relaxed man.

“As he came out of the anesthesia, the surgeon, John Collins Warren, said ‘Mr. Abbott, did you feel pain?’ and Abbott said, ‘Did you begin the procedure?’ ” Herman recounted. “The world changed. Within days, news of what happened here traveled by steamship and by locomotive … to the capitals of the world.” Continue reading

Harvard Poll On Ebola Risk Finds Public Dazed And Very Confused

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

By Richard Knox

Americans are seriously confused about how Ebola spreads. And it’s no wonder.

A new national poll from the Harvard School of Public Health finds that nearly 9 out of 10 Americans think someone can catch Ebola if an infected person sneezes or coughs on them.

Not so, according to all health authorities and 38 years of research on this virus. But maybe people can’t be blamed for thinking Ebola can be spread through the air as they see powerful images day after day of health workers clad in head-to-toe protective coverings and face masks.

And there’s little to no possibility that Ebola will mutate into a virus easily spread by aerosol droplets, like influenza or SARS, for reasons that Laurie Garrett of the Council on Foreign Relations recently pointed out in The Washington Post.

Similarly, all the attention on the imported Ebola case of a Liberian man in Dallas and subsequent infection of two of his nurses (so far) is apparently leading many Americans to overestimate their risk of getting the virus.

In contrast, the great majority (80 percent) think they’d survive Ebola if they got immediate care. That’s probably right — though no sure thing.

(Courtesy of Harvard School of Public Health)

(Courtesy of Harvard School of Public Health)

The Harvard poll, conducted between last Wednesday and Sunday, finds that a little over half of Americans worry there will be a large outbreak of Ebola in this country over the coming year.

More than a third worry they or someone in their immediate family will get Ebola. Continue reading

For Hospitals And Clinics: Insurance To Protect Against Losses From Ebola

A Boston-based insurance broker is rolling out a new policy for Ebola-related losses at hospitals and clinics across the country.

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

How much money might hospitals lose during an Ebola-related quarantine? And will patients use hospitals that treat the virus? Phil Edmundson at William Gallagher Associates developed Ebola insurance to address these risks.

“People may choose to put off their health care, or to get it at an alternative facility, if they feel there’s a reason to suspect Ebola in a given clinic or hospital,” Edmundson said.

Ebola policies could run half a million dollars or more for large hospitals. They will not cover the cost of closing off wards, training staff or overtime.

Other insurers are offering similar coverage for theaters, restaurants, hotels and other public spaces that may have to close if they have a customer with Ebola.

“All Massachusetts hospitals have general insurance policies and liability policies in place for extreme events,” the Massachusetts Hospital Association said in a statement.

The group said it’s aware that hospitals in the state may be evaluating whether “additional insurance for Ebola-specific events” is necessary.

More Coverage:

Selling Mass. On A New Idea: Shop For Care

(Screenshot from Get The Deal On Care)

(Screenshot from Get The Deal On Care)

Could Massachusetts be the only government in the world trying to persuade citizens to shop for health care? I’m scanning Google, trying to come up with another country, province, city…maybe some remote island that has decided: It’s time to learn how to get the best deal you can on care.

Nope, I can’t come up with any other place.

But here it is: Get The Deal on Care. In addition to the website, you may see ads on the T, Twitter or Facebook that will encourage patients to become more savvy consumers of health care.

“We’re at the beginning of a movement here,” said Barbara Anthony, undersecretary for consumer affairs and business regulation, referring to a provision in a Massachusetts law that took effect Oct. 1. It requires all insurers to make real-time prices available to members online and over the phone, and provide members their cost for the service, taking into account co-pays and deductibles.

“We hear about the dawn of patient-centered care,” she said. “We want to put patients in the driver seat. Well, you can’t put consumers or patients in the driver seat if they don’t have information.”
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8 Things You Need To Know About Ebola

Cpl. Zachary Wicker shows the use of a germ-protective gear in Fort Bliss, Texas, Tuesday, Oct. 14, 2014. About 500 Fort Bliss soldiers are preparing for deployment to West Africa where they will provide support in a military effort to contain the Ebola outbreak. /Juan Carlos Llorca/AP)

Cpl. Zachary Wicker demonstrated the use of a germ-protective gear in Fort Bliss, Texas on Tuesday. (Juan Carlos Llorca/AP)

Ebola has been dominating the headlines lately, raising concern about the disease potentially spreading to Massachusetts. And after two recent Ebola scares in Boston, local authorities are also trying to reassure the public.

Here’s what you need to know about Ebola:

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Mass. Officials Try To Quell Ebola Fear

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

At this moment, in Massachusetts, the fear of Ebola may be more troubling than preparing for the possible cases.

Gov. Deval Patrick and Boston Mayor Marty Walsh pulled their top health, police, fire and transportation leaders into a briefing Tuesday morning and then addressed the public from Logan Airport. Their message: We’re ready, don’t worry.

Sometime Sunday afternoon, as word spread that a Braintree patient was being screened for Ebola, the fear factor in Boston spiked. Could this virus that’s killed 4,447 people as of early Tuesday in West Africa be in our midst? I heard from moms who were disinfecting playground equipment, from colleagues whose parents called with worry, and Walsh says his phone was ringing off the hook.

“I know this weekend was very fearful for a lot of people,” Walsh said, “but in the case of an Ebola case, we were prepared for it.”

Ebola has been ruled out in all of the scares this weekend — that Braintree patient and the five sick travelers who landed at Logan Airport from Dubai. Patrick says there have been several dozen cases in Massachusetts where doctors or nurses suspected Ebola and took precautions.

“I want to make clear that there have been no confirmed cases of Ebola in Massachusetts,” he said. “Each of the individuals that I referred to have been examined and Ebola has been ruled out.”
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What The Boston Marathon Response Can Teach Us About Ebola: 5 Lessons

By Leonard Marcus, Ph.D, Barry Dorn, M.D., Richard Serino and Eric J. McNulty, M.A.

The massive and growing Ebola outbreak in West Africa is tragic both in the suffering and deaths among the affected population and in the difficulty of mounting a sufficient response. The number of cases is rising exponentially. We have had the first death in the U.S., the first case of someone contracting the disease in this country and the first case of transmission in Europe. Over the weekend, a man who had recently traveled to Liberia was taken to Beth Israel Deaconess Medical Center to be evaluated for possible Ebola.

Fear and anxiety are rising.

This has the potential to be the defining public health crisis of the 21st century. Boston has stepped up by sending doctors and other health care professionals with extensive experience and expertise. There is, however, something more that Boston has to share: the leadership lessons from the Boston Marathon bombing response.

(Ebola in Guinea/European Commission HG ECHO/flickr)

(Ebola in Guinea/European Commission HG ECHO/flickr)

After the Marathon, we saw federal, state and local agencies, as well as organizations in the private and non-profit sectors, came together as an integrated enterprise that can serve as a model for the Ebola response. While the two events are quite different, the principles for leadership effectiveness are actually similar.

There are five key interrelated lessons from Boston that can be useful as the world confronts Ebola:

Build A United Effort

An effective Ebola response requires linking and leveraging many organizations into a collaborative, cooperative enterprise, much like we saw in Boston after the bombing. Continue reading