If you’re looking for a hook on which to hang your anxieties about Ebola, start with Washington’s nurses.
The Washington State Nurses Association has been surveying its members statewide, asking whether they feel they’ve been adequately trained and equipped to deal with the fatal and fast-moving disease. Most of them are saying no.
Public health officers, hospital officials and leaders who monitor the medical system from higher altitudes are reassuring the public that the Ebola virus will hit a brick wall if it gets off a plane at Sea-Tac Airport. From their vantage point, it no doubt looks that way.
In Tacoma, for example, the MultiCare Health System and Franciscan Health appear to be taking strong precautions. We presume that’s true of major treatment centers throughout the Northwest.
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But the virus doesn’t demand to be taken to Tacoma General, St. Joseph Medical Center or Harborview in Seattle. It can enter the system through any clinic or stand-alone doctors office. It can enter through the ambulance that takes an infected patient to the hospital. Panic is the wrong response, but so is a false sense of security.
Several factors make Ebola more worrisome than most communicable diseases.
It kills very effectively: The World Health Organization has just increased its estimate of the mortality rate from 50 percent to 70 percent. That rate should be considerably lower in an advanced nation like the United States, but no one has a cure.
For a virus that can’t go airborne and isn’t carried by insects, Ebola infects with alarming ease. It wasn’t particularly scary that an infected man from Liberia showed up in Dallas last month and died from the disease. That was going to happen sooner or later somewhere in the United States. What was scary was the fact that one of his nurses got infected in a modern American hospital – despite protective gear and presumably after avoiding bodily contact.
The U.S. Centers for Disease Control was advising Texas Health Presbyterian Hospital at the time. So far, reportedly, the CDC hasn’t figured out what nurse Nina Pham did “wrong.” It’s probable that she followed the CDC protocols with great care.
On Monday, CDC officials admitted that the protocols themselves might have been inadequate. “We have to rethink the way we address Ebola infection control,” said its director, Dr. Thomas Frieden, “because even a single infection is unacceptable.”
The humility of that admission is refreshing. The advance of Ebola has been marked at every turn by official reassurances that existing safeguards were sufficient and adequate precautions were being taken.
The exception to those safeguards lies in the countries – Guinea, Liberia and Sierra Leone - where the virus continues to spread at an astounding rate. The WHO on Tuesday estimated that new cases in affected parts of West Africa could reach 10,000 per week in December. Ebola must somehow be stopped there, or it will be carried to cities around the world. In that case, the Dallas scenario will be repeated frequently in areas far less prepared to deal with it.
The most dangerous thing about Ebola may be the way it attacks the very people who fight it. Doctors, nurses and aides must get close to patients to treat them. In Africa, the disease has been cutting a cruel swath through the medical profession. The heroic Doctors Without Borders – professionals respond to these crises at great personal risk – just reported that 16 of its staff members have been infected, and nine have died. Most of these infections seem to have happened in relatively advanced treatment centers.
Nurses in Washington should be taken very seriously when they say they aren’t prepared. They occupy the front lines of health care. When Ebola walks through the door, perhaps looking like the flu, it will likely be a nurse who takes the patient’s temperature, checks his pulse and reviews his history. That nurse must know exactly what to look for and how to respond.
If Washington’s nurses don’t feel ready, it’s a good bet the region isn’t nearly as ready as it must be.