The Eboli issue

One of the nice things about this blog is that I can write almost anything I want.  Since no one reads it but me, it doesn't matter what I write.  FREEDOM!

Obviously, I have been interested in the Eboli issue.  I was on the Infection Control Committee for 29 years before I retired.  A couple of comments cry out to be made.

Eboli is a very deadly virus.  It has a 50% mortality rate in West Africa.  It requires a major effort to contain.  However, the world has ignored the problem and until now has offered no assistance to the poor countries in the area.  Despite our assurance that the US has the best health care system in the USA, there are major gaps in the system.  Very few of the 5500 acute care hospitals are equipped to handle a case of Eboli.  In NY there are 4 hospitals in the city and 2 on Long Island that can handle the disease.  There are no hospitals in New Jersey specially equipped to do the job.  If NJ wants to have one, it should pour all necessary resources into that one facility and not require or expect all acute care hospitals in the state to become capable.  That is an unnecessary extraordinary expense to impose.

The Centers for Disease Control has a voice but no teeth.  It can make recommendations.   Hospitals do not have to follow those recommendations.  As someone pointed out, they don’t even have to read the recommendations.  There is no downside to not following CDC recommendations, although a smart lawyer might bring up the issue in a malpractice suit.  The CDC cannot go to a hospital without an invitation.  The decision rests totally with the hospital and the physicians taking care of the person.  If they believe that they can handle the situation, they don’t have to ask anyone for help. That statement applies to any episode of care.  To me the best physician knows his limitations and knows when to ask for help by calling a consult or referring a patient to another facility.  I might suggest a level of arrogance among physicians, but would anyone believe me?  Why else did Nancy Sniderman leave isolation?  She decided that as a physician, she did not have to follow the rules!  She knew better!

When a friend of mine was very ill in a local hospital, the cardiologist tried to review the Echocardiogram and honestly told me that she did not know what she was seeing. She strongly recommended that we take the patient to University of Penn.  That is a good doctor!

Since the CDC cannot impose protocols on a hospital, neither can NIH.  I don’t know the power and authority of a Surgeon General, but the US does not have one.  The candidate suggested that guns kill people and his Senate confirmation was blocked by the NRA lobby.

The Medical Center in Dallas believed that they could handle the patient with Eboli.  They initially misdiagnosed his condition in the ER.  The isolation precautions should have been complete from the very beginning of care.  Unfortunately, it took hours to days for the proper procedures to begin.  Therefore, people were exposed to the disease.  Apparently that Medical Center could not handle the disease.

People are panicking about the disease.  The news media are not helping.  Neither are politicians and talks show hosts who claim a government conspiracy or that Obama introduced the virus into America.  Senator Paul, who is a physician, stated misinformation about the disease for political gain.  Inflaming the public, especially the right wing fanatics is unethical as a physician and irresponsible as a Senator.