US doctors: With proper protocols, no need to panic over Ebola

Emergency room physicians say that if proper protocols are applied, the risk posed by Ebola doesn’t have to be significantly more threatening than the dangerous situations and pathogens doctors face in their everyday work.

“There certainly is a risk. This isn’t just measles or the chicken pox. It’s an unknown. But I don’t feel personally at risk at this point in time,” said Dr. Robert Glatter, a spokesman for the American College of Emergency Physicians (ACEP) and an attending physician in the department of emergency medicine at New York City’s Lenox Hill Hospital.

Many who labor daily on the front lines of medicine say that although there is heightened concern, they do not feel their safety is at imminent risk. They also said they don’t believe there is a potential for a large Ebola outbreak in the U.S.

“I feel safe knowing we have protocols in place and knowing how the virus is transmitted. I’m very comfortable at this point saying I don’t feel there will be an outbreak in the U.S.,” said Glatter. “I think there are going to be more cases than we’re seeing right now, but I don’t think it’s going to be a large number.”

Dr. Stephen Epstein, also of ACEP, said while he’s concerned about the virus’ presence in the United States, he is not overly worried about his safety while practicing medicine.

“Among health care workers, this is nothing terribly new. We deal with virulent pathogens all the time — patients who have meningitis and tuberculosis. Ebola is hard to catch. It is not airborne. Just like hepatitis C and HIV, it is spread through body fluids. We’ve been dealing with precautions for that for a long time,” said Epstein, who practices emergency medicine at Boston’s Beth Israel Deaconess Medical Center and is an assistant professor of medicine at Harvard Medical School.

Epstein said precautions for Ebola will be more stringent because doctors know less about it than, for example, influenza or enterovirus D68, which is causing paralysis in children.

In terms of protecting his health, Epstein said, “The biggest thing was just wanting to know what our plan is for Ebola. Now we have a plan in place. The CDC [Centers for Disease Control] has been assisting with that. Once you have the plan, you feel a lot more comfortable about it. You know the equipment is there, how the virus is transmitted and how to proceed, who to call, what the resource are and how to protect the staff while caring for a patient with Ebola — and how to protect other patients. That eases concerns among hospital staff. It’s just a matter of sharing knowledge. Good knowledge is a powerful thing.”

Glatter felt confident about the protocols that have been put in place at Lenox Hill Hospital: screening patients with West African travel histories, isolating patients of concern and having personal protective equipment ready for use, including surgical boots, gowns and neck protection.

“The leadership from emergency medicine here have been in contact with officials from the New York State Department of Health as well as the CDC,” he said, adding that there have been meetings and email communications with diagrams and procedures and that training on how to deal with Ebola patients has already began.

Still, others are unnerved after hearing last week’s news of two Dallas health care workers who tested positive for the virus after caring for Thomas Eric Duncan, the first person who died of the disease in the United States.

Glatter said some nurses have a higher level of unease. “We’re all on the front lines, but nurses in particular,” he said.

Deena Brecher, president of the Emergency Nurses Association, said having a screening process in place for suspected Ebola patients — the CDC checklist that helps health care workers determine if a patient is low or high risk — has been key to boosting confidence among emergency room nurses.

“From that perspective, I’m very comfortable. But when Nina [Pham] the Dallas nurse got sick, that’s when it hit home. You are out there taking care of patients like she does. We don’t care who you are or what you look like. That’s what we do. But that news, for all of us, added a level of uncomfortableness,” said Brecher, a pediatric emergency room nurse.

Nurses at Texas Health Presbyterian Hospital in Dallas alleged that Duncan was left in an open area of an emergency room there for hours and that the nurses worked for days without proper protective gear and faced constantly changing protocols, according to a statement released on Oct. 14 by National Nurses United, the largest U.S. nurses’ union.

“The system failed in Dallas. What happened in Dallas probably could have happened at any hospital this country. We need time to practice before a patient comes in, to learn how to put protective gear on and how to take it off using the buddy system that the CDC recommended. We can’t wait until that patient comes into an emergency department. Every emergency department should be doing it and simulating with fake patients now how to isolate and get them to where they need to be,” Brecher said.

Wendell Watson, a Texas Health Presbyterian spokesman, did not respond to specific complaints by the nurses but said the hospital has not received similar statements.

“Patient and employee safety is our greatest priority, and we take compliance very seriously,” he said in a statement. He said the hospital would “review and respond to any concerns raised by our nurses and all employees.”

Firefighter and paramedic Sgt. Stephen Borders, president of the Atlanta Professional Firefighters Association, drives a ladder truck that handles all the fire and medical emergencies at Hartsfield–Jackson Atlanta International Airport. The city is home to the CDC and Emory University Hospital, where three patients have been treated for Ebola.

He said he and his friends, some of whom work in hospital settings, have been talking a lot about Ebola. He said he feels more confident about his safety than friends who work in hospital emergency settings.

“Ebola has been extremely eye-opening for us. The standard precautions we’ve always used are not going to be enough,” said Borders.

The firefighters are developing Ebola-specific protocols and upgrading their general infectious disease protocols, he said.

“It’s much easier for us to get a little more equipment than for the hospital to create separate entrances for febrile patients and negative-pressure rooms and isolation areas versus nonisolation areas. We are well protected and have all of the gear we need, all the way up to an encapsulated suit and air supply,” said Borders.

Brecher said health care workers, especially those working in quarantined patients, need support to deal with the stress.

“There are motor vehicle incidences where someone you know is killed or you have a child die,” she said. But the emotional toll on health workers who have been exposed to Ebola can be “incredibly horrible” too.

Glatter said, “This is not just a medical issue but a psychological issue. Quarantine is like having the scarlet letter on you. Will the community view you as someone who can’t be approached or spoken to and dealt with? That’s a concern I would have for those people who’ve been infected.”

“There’s PTSD [post-traumatic stress disorder] from this kind of close encounter with death, and it can leave scars … People’s fears are not backed up by scientific fact, but still people are approaching you differently because you’ve had [or been exposed to] Ebola,” he said.