Dr. Casscells special: The Ebola epidemic

There is a lot of misunderstanding around the recent Ebola outbreak. There is reason to feel safe from the disease based upon its prevalence or density in our population.

There is also good reason to be concerned about the disease and act proactively, due to the extremely high death rate associated with the Ebola virus. It kills approximately 70% of those infected and is nearly impossible to treat large populations of people. In these cases of historically dangerous epidemics, the rate at which the disease can spread is critical, which is directly related to the degree of mobility in the worldwide population, now far greater than at any previous time.
It is about the travel. In ancient times ships returning from far away places were required to lay at anchor for at least a few weeks before being allowed to dock and disembark, quarantine. When polio and tuberculosis were epidemic we isolated those populations in sanatoriums or for immigrants at Ellis Island in New York where if they were found sick they were sent home. These are tried and true methods of slowing disease spread until we can develop better treatments, cures, or vaccines.
People have died from Ebola in every country in Africa, and most in Europe so there is a very high likelihood that we here in the US will encounter the disease soon enough. In a few months we may be able to produce more experimental medication but it would be completely outside of usual deliberate FDA protocols. Training all hospital workers and emergency personnel or others likely to come in contact with the Ebola victims is essential. Gowning and gloving and masking are important, but degowning (taking off the hospital gown properly), unmasking, and degloving are far more important. All of the recent cases have been traced to poor technique degowning. While watching a CDC  official do a television demonstration of this last week, I saw three separate errors degowning. They do it the way medical personnel on an isolation floor do it, not the way we do it the Operating room. Learn the latter technique, not former. Handling the waste and corpse is critical. They must be incinerated.
Any way you look at it 21 days of quarantine is essential to halting the epidemic.
C.D.Casscells,MD
Director of Health Policy Division
Caesar Rodney Institute

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