With the spotlight on Ebola during the last month, a focus also is shifting to the people at the frontlines caring for those patients.

Ebola is a deadly virus that has devastated five African countries since March. More than 4,600 cases and 2,400 deaths have been reported since then. The virus was first identified in 1976 with sporadic outbreaks throughout the years. Outbreaks of the past were typically in rural areas, but the virus is now in major cities. The number of cases is expected to climb rapidly.

Health officials said the spread of Ebola is possible in these areas because there isn’t a strong public health infrastructure that helps with treatment and containment like in the United States.

Dr. Richard Wallace, an infectious disease specialist at UT Health Northeast, spent some time in Monrovia, Liberia about 10 years ago while on a mission trip before Ebola surfaced there.

“This is a disaster because it currently involves five countries, so how are we going to end up isolating all of these people?” Wallace asked. “But that’s the goal. That’s how you approach these kinds of outbreaks.”

Meanwhile, there are only three known cases in the U.S. but missteps and questions about the disease have heightened the public’s concern. However, health officials said there is a minimal risk that the general public will contract Ebola.

“We need to do intelligent things, but we do not need to panic,” said Dr. Kirk Calhoun, president of UT Health Northeast. “Panic is the worst thing.”

 

PROTECTING THE PROVIDERS

Calhoun has said that staff at UT Health Northeast will step up measures to protect health care workers who may come in contact with someone who has an infectious disease.

Even the front desk clerk at clinics and the hospital’s emergency department will be trained to ask specific questions about travel history and symptoms.

“There are still a lot of questions that need to be adequately answer, so exercising reasonable caution is appropriate,” Calhoun said.

While two Dallas nurses fight the virus after treating Thomas Eric Duncan, the first patient diagnosed with Ebola in the U.S, nurses across the country are voicing their concerns.

Don Hunt, chief nursing officer at UT Health Northeast, said he understands why nurses would be worried.

“Everybody is anxious about this,” Hunt said. “If they aren’t, that would surprise me because there are things that we don’t know about it. However, what I am confident of is that if we follow through with our procedures then our nurses are protected.”

Hunt said there are three types of exposure workers protect against: Contact, droplet and airborne. The CDC has recommended precautions for contact and droplet exposure, since Ebola is not airborne. UT Health Northeast officials said they want to go further.

“Ebola has changed that because now what they say is wearing a gown is not enough,” Hunt said.

Booties, leg coverings, double gloving, a mask, face shield and head covering are among the equipment for complete protection. But how someone puts the gear on and takes it off can possibly lead to contamination.

“We are looking at the process to make sure we’re doing that correctly,” Hunt said. “We are looking at that to see if they have someone who takes that off for you.”

Wallace said a full suit and respirator would be ideal for health care workers.

“I think we should err on the side of safety with a disease we don’t know a lot about,” he said.

Yvette Mackey, who has been a registered nurse for 18 years, feels uneasy with the knowledge they have now.

“It really bothers me, and it does worry me,” she said. “My concern is that I don’t think anyone is really prepared for this. You can do your best. You treat each patient as if they were contagious. You glove up, wash up before you go in the room, and you just do your best to take care of them.”

Ms. Mackey listened in on a nationwide conference call held by a nurses’ organization last week, in which they chided criticism of nurses and demanded more training and adequate protective gear. She said she respects what they were standing for and just wants to be informed and protected.

“If we did get an Ebola patient, and we had to take care of them, I would take care of that patient,” Ms. Mackey said. “That’s my duty, and that’s what I went to nursing school for, and I’ve never turned down or refused to take care of a patient because they had an infectious disease, or something very contagious. I couldn’t live with myself if I refused to take care of it myself or I refused take care of them. My concern is I just want to make sure we have the proper gear and the proper equipment to handle this kind of patient.”

 

THE MYSTERY OF EBOLA

Wallace said there is so much to learn about Ebola. The current outbreak is more deadly than others in the past, with possible genetic changes.

“It belongs to a family of viruses called hemorrhagic viruses, that is, they produce marked increases in the blood clotting factors so that people bleed into their skin, their mouth and internally.”

These hemorrhagic viruses are most associated with a high mortality. Wallace said in patients with Ebola, blood is visible under their skin and in the whites of their eyes.

“This inability to clot results in damages to all the body organs and a name for it is multi-organ system failure,” he said. “This is not an uncommon endpoint with patients with overwhelming infections due to anything. When they reach that stage, it’s almost always fatal. Even if you kill the virus, you can’t reverse that’s been done to your base life systems, your organs.”

Incubation can take up to three weeks. Patients first ache all over and have headache and fever. That’s followed several days later with nausea, vomiting, diarrhea and frequently bleeding, Wallace said.

There’s no specific therapy for Ebola, only supportive care.

“There are some experimental drugs, and they are trying transfusions from people whoever had the virus and have recovered, and therefore they have antibodies in their bloodstream,” Calhoun said. “Whether that works or not, I don’t know anyone knows for certain.”

Ebola is different from other infectious diseases because it’s much more virulent.

“These body fluids must be so infectious, there is some data from a previous study that viral counts in the blood stream reach 1 million particles per 1 milliliter of blood,” Wallace said. “To give a better example, that’s 50,000 particles in a drop of blood. … So the contamination in the room (with the nurses) was probably substantially higher than it was at the time he was with the family.”

Wallace said last week he believes the current recommendations might be inadequate considering health care workers have several hours of contact with infectious patients.

On Saturday, the CDC announced it would soon reveal new guidelines for protective gear. WHO, or the World Health Organization, also will speak publicly about the Ebola response.