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VOL. 129 | NO. 215 | Tuesday, November 04, 2014

Local Ebola Response Rolls With Changes

By Bill Dries

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The medical and public health response to Ebola has changed since the disease came to America because the science around the disease has changed in that time, says the infectious disease consultant to Baptist Memorial Health Care.

“It’s very rare that the guidelines change at the pace of change for Ebola,” said Dr. Manoj Jain on the WKNO-TV program “Behind The Headlines.” “We’re talking about days and weeks.”

“We were preparing,” added Dr. Helen Morrow, chief health officer of the Shelby County Health Department. “But I don’t know that we were really thinking we would have an actual case as immediate as we did.”

The program, hosted by Eric Barnes, publisher of The Daily News, can be seen on The Daily News Video page, video.memphisdailynews.com.

Morrow is talking about the October case of Thomas Eric Duncan, who died in Dallas last month after traveling back to the U.S. from Liberia – the first person to bring a diagnosed case of Ebola to the U.S.

Duncan’s case resulted in the Centers for Disease Control changing the guidelines handed down to health departments and from there to hospitals regarding a coordinated response to Ebola.

“It is not worthwhile for us to train an entire hospital staff ... in every single hospital in America.”

–Dr. Manoj Jain, Baptist Memorial Health Care

“The general public does not need to panic about Ebola,” Jain said. “The group that has to be concerned is the health care community because we have seen that it can spread very quickly within a hospital setting – within a health care community, as we’ve seen in Africa.”

Because of the rarity of Ebola in the U.S., Jain said, that dictates a specific response in training health care professionals stateside in the response.

“It’s a low-probability disease,” Jain said. “It is not worthwhile for us to train an entire hospital staff on management in every single hospital in America. That is just a waste of our time, effort and resources.”

A patient who walks into a hospital emergency department and says he or she might have Ebola triggers responses that could include isolation or quarantine once doctors determine how likely it is that they are dealing with Ebola.

“As an infectious disease doctor, I cannot tell a patient that has Ebola or has malaria or who has typhoid fever at the initial presentation unless I get laboratory tests,” Jain said.

That means a suspected case goes to one of several designated local hospitals from an emergency department.

Meanwhile, Jain has advocated for a dramatic increase in the number of biocontainment centers in the U.S. from the current four to 300. He pitched the idea, with an estimated cost of $15 million, to U.S. Sen. Lamar Alexander of Tennessee during a town hall forum in October.

Morrow said the considerations for such a center are broad.

“You have to have a specific cadre of personnel that are trained specifically for that,” she said. “It also requires a change in the physical layout of an institution to perform the duties and protect the health care workers and the patients most appropriately. It would be a set number of people that would be doing this.”

Jain compares it to hazmat teams that respond to incidents involving hazardous materials.

“You’ve got individuals that are highly trained,” he said. “They know how to put on and take off that suit, which is incredibly difficult.”

Morrow acknowledges that some of the response takes into consideration public reactions apart from the scientific and medical realities of Ebola.

“Part of this is in response to a great deal of public concern and misunderstanding about this disease. Sometimes you will overreact to public concerns. There seems to be a bit of that,” she said of Kaci Hickox, the Maine nurse who challenged her New Jersey quarantine after she returned to the U.S. from working with Doctors Without Borders in Sierra Leone.

“Scientifically, she does not – according to the guidelines – have to remain in one place,” Morrow added. “But there is such a great concern from the public that sometimes it’s better if you behave in certain ways to help assuage concerns and fears.”

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