If all goes as planned, Dr. Nahid Bhadelia will soon head straight into the heart of the Ebola outbreak that has already killed more than 700 people in western Africa, including at least 50 health care workers. Global and U.S. health authorities announced Thursday that they would ramp up efforts to bring the epidemic under control, but that it would likely take at least three to six months.
Dr. Bhadelia is director of infection control at the National Emerging Infectious Diseases Laboratory in Boston and a hospital epidemiologist at Boston Medical Center. She’s slated to travel to Sierra Leone in mid-August, to share her expertise on infection control and also care directly for Ebola patients. Our conversation, edited:
This is the biggest Ebola outbreak ever, as far as we know. Is it notable in other ways?
This is the first time Ebola has been present in these three countries: Sierra Leone, Guinea and Liberia. Because these countries haven’t seen the infection before, that impacted their ability to recognize and manage the infection early on.
Also, because of the recent travel of the American Patrick Sawyer to Lagos [where he died of Ebola], I think it has raised a lot more concern about transfer of Ebola abroad, which has not been much of an issue in the past.
A lot of the U.S. media coverage has focused on, ‘Could it come here?’ Part of that fear seems to stem from the sense that Ebola, with its hemorrhages and high death rate, is particularly horrible. Is it?
In some ways yes and in others no. Ebola Zaire, the strain we’re seeing right now, is one of the most deadly strains; it’s been shown in the past to have 90 percent mortality when no treatment is given. But in some ways, it’s much harder to transmit at a population level compared to respiratory viruses we’ve been hearing about such as SARS or MERS. It requires close contact with bodily fluids. So, for example, there’s been a lot of concern about travel of folks from the areas impacted to the developed world, and I think the reason it’s less likely to spread is because it’s limited to people who come into contact very closely with the person who’s impacted.
So many health care workers have been getting infected. Do you have a sense of why? Are there practices that might be easily correctable that you could have an impact on?
There are a lot of talented people there in the field already, not just from international organizations but people who’ve been working there a very long time. In Sierra Leone, for example, though they haven’t had Ebola before, they’ve dealt with Lassa fever, another viral disease that causes hemorrhagic fever, at Kenema — one of the places where Dr. Khan, the leading physician who just died of Ebola, worked. That center has dealt with Lassa fever for over 25 years, and there are nurses there who have long experience. The issue is the amount of patients. You have nurses there who were taking care of maybe a dozen Lassa patients and now they have to see 70 Ebola patients. I think the major issue is the fact that the health care system is so overwhelmed.
One of the major ways to alleviate that would be the presence of more personal protective equipment and more sterile medical equipment in general. I know that the PPE — the personal protective equipment — is a major concern because there’s a dearth of it right now in the field.
Also, we understand that the virus can be transmitted from surfaces — so if someone comes into contact with bodily fluids with the virus in them on a surface, that’s another way to get it. The virus can live outside the host for a couple of days. So this contamination of the environment is another important component — and that’s very difficult if you can imagine 70 patients in a small space. Ebola is not hard to kill, so it’s easy to avoid contamination in general. It’s only because of the number of people and poor health infrastructure that it becomes difficult.
Still, it’s so baffling that these leading, incredibly knowledgable doctors are getting infected. How can that happen? Continue reading