October 20, 2014
A Look At Ebola
By Michael D. Shaw
Ebola virus disease (EVD) was first identified in 1976, in what was then called Zaire (now the Democratic Republic of the Congo). The name comes from the Ebola River, a tributary of the Congo River in central Africa, where the majority of EVD epidemics have occurred. However, recent outbreaks are now in Western Africa, and involve major cities, as well as rural areas. WHO pegs the average EVD case fatality rate at around 50%. Outbreaks in the past have logged case fatality rates of 25 to an astonishing 90 percent.
Recently, symptoms of this dread disease have been well-publicized. Indeed, the virus seems more like the lurid creation of a sci-fi writer than a real-life pathogen. Massive hemorrhaging is caused by its diabolical ebolavirus glycoprotein. Normal coagulation mechanisms are defeated, neutrophils (a type of white blood cell, important in immune function) are short-circuited, and cytokines (responsible for the inflammatory process) are unleashed. The end result is that the sufferer is being killed in multiple ways.
Some authorities add that even if you don’t have blood dripping from your eyes, your leaky blood vessels can be enough to cause shock and then death. WHO advises early supportive care with rehydration and symptomatic treatment to improve survival. While there is currently no licensed therapy proven to neutralize the virus, a number of blood, immunological, and pharmaceutical agents are under development. Two potential vaccines are now undergoing evaluation. Notably, the virus can be killed quite easily with chlorinated water.
As of this writing, patient zero in America—Thomas Eric Duncan—has died, and at least two health care workers associated with his case have been diagnosed with Ebola.
The US Centers for Disease Control and Prevention (CDC) have been roundly criticized—and rightly so—for their handling of the Ebola matter. However, the politicization and flagrant injection of political correctness into public health is nothing new, and is hardly confined to the CDC. Many will recall that during the AIDS hysteria, for reasons of “privacy,” the death certificate did not always reflect the actual cause. But such misrepresentations of the cause of death were already occurring in the 17th century. According to journalist/author Kathryn Schulz, the practice was sufficiently common in 1930s New York City, that in addition to the death certificate, a confidential medical report of death, which included the true cause, was also issued.
For the worst case scenario of politics mixing with public health, see Mengele, Josef.
Infection control guru, and friend of this column, Lawrence Muscarella, PhD offered several insights during a recent conversation. He questions the whole notion of the CDC “working with” hospitals. In accordance with federal guidelines, the CDC must be called in by the hospital, so the relationship might just be a bit too friendly to be effective. More than that, Muscarella has always challenged the “everything is rosy” hospital-acquired infection self-reporting that is virtually never audited by an independent third party. As such, how do we know that we’re being told anything near the truth about Ebola?
Consider the sad business of Superbug carbapenem-resistant enterobacteriaceae (CRE) infections at Pittsburgh’s UPMC Presbyterian Hospital. In November, 2012, the facility began investigating 18 cases of CRE infection, that were eventually traced to a contaminated medical device used in Endoscopic Retrograde Cholangiopancreatography (ERCP). Apparently, some of these patients died, but officially, none of the deaths were “directly related” to the CRE infection. Inasmuch as CRE is fatal in 50% of cases, how likely is it that none of the 18 succumbed to the superbug?
Muscarella also reminded me of two instances in which the water supply of VA medical centers (Iowa City and Pittsburgh) were contaminated with Legionella. At the Pittsburgh VAMC, 29 patients were diagnosed with Legionnaires’ disease, and at least two died. Records indicated faulty maintenance procedures. At Iowa City, patients were not warned of the situation, presumably because it was “under control.” Heck, they even trotted out “experts” who assured everyone that “Legionella bacteria pose little risk to young, healthy people. The germs are most likely to sicken people who are elderly and frail, especially if they have immune-system problems or are smokers.”
Hello? Think that description might fit some (even many) VA patients?
An anonymous Iowa City VA staffer revealed that he and some co-workers now drink bottled water at the hospital, and found out that there have been at least 23 positive test results for the bacteria. The Des Moines Register attempted to get a confirmation of this number, but were rebuffed with a bureaucratic CYA response. Bear in mind that in many cases, record-keeping at VA medical centers is far superior to what goes on at other hospitals.
Now, for the scary part. We have heard from individuals at Texas Health Presbyterian Hospital, where Thomas Eric Duncan died—and other facilities—that they are not adequately trained to deal with Ebola. But, other than its horrific symptoms, there is nothing magical about that virus, or how it is transmitted. After all, there are only three methods of pathogen transmission: Contact, droplet, and airborne. For some organisms, one or more methods may apply.
Does this mean that they are not trained to handle such as CRE, tuberculosis, and measles, either? Has the specter of Ebola suddenly shined—at long last—a dazzling spotlight on hospital infection control?