The Ebola outbreak in West Africa is truly terrifying. The New England Journal of Medicine's lead article in the Oct. 16 issue states that "the current epidemiological outlook is bleak" in Guinea, Liberia and Sierra Leone and that "unless control measures improve quickly, these three countries will soon be reporting thousands of cases and deaths each week."
Closer to home, Americans are wondering what the risks are of an Ebola outbreak here. The first cases in the U.S have led to concern and a sense of powerlessness in the face of a possible epidemic. But there are effective strategies — not yet fully considered — that allow average citizens to make a positive impact.
More than ever, it's important that as many of us as possible get a flu shot. That won't protect people from Ebola, but it will reduce the number of people coming to emergency rooms, clinics and doctors' offices to be evaluated for symptoms. As we know, early Ebola symptoms can be non-specific, mimicking the flu and other common maladies. Patients flooding ERs with ambiguous symptoms could set off a cascade of actions, including quarantine, protective equipment and extensive testing. The fewer the patients, the better the care for people who are more seriously ill. Some choose to forego flu shots, figuring they'll take their chances, gambling on the herd effect of other people getting vaccinated. This is one year where good citizenship mandates that all of us who can get the flu shot make sure we do.
Citizen awareness and vigilance has a key role. It's not hard to know what the Ebola risk factors are: travel from affected areas, contact with a person at risk for Ebola and early symptoms of the disease (fever, nausea, headache). Those who think they or someone else is at risk of Ebola ought to be able to call a national or state hot line. The hot line, staffed by knowledgeable personnel, could do an over-the-phone evaluation to determine true risk. The last thing we want is people traveling to a health care facility if it's not immediately needed. That would put others — the general public, other patients, hospital personnel — at risk and possibly force them into confinement in quarantine, as we've seen recently with airline passengers and others.
Although our hospitals are ramping up with staff training, the reality is that it's a major challenge to bring so many health professionals up to speed in a short time with complex protocols involving personal protective equipment (PPE), handling of specimens, trash removal and myriad other considerations.
As a career ER doctor, I know that it's hard enough to diagnose and treat illnesses and injuries with which I'm very familiar. In this case, we would be asking health providers to diagnose and treat a serious illness virtually none of us have ever seen. Even the act of putting on and taking off PPE is daunting, and the experts tell us that a small mistake can be fatal. The reality is that most ERs and hospitals would grind to halt if they were called on to initiate full Ebola protocols, and that would adversely impact the care of patients with the usual problems seen in ERs from heart attacks to ear infections to major trauma.
Maryland's recent move of designating three hospitals as Ebola care sites was a good first step, but why not also develop regional "SWAT" teams of Ebola hazmat experts? Rather than bring the patient to institutions for care, why not have them evaluated at home first? SWAT stands for Special Weapons and Tactics, which are exactly what is needed to address a potential epidemic. In this case the weapons and tactics will consist of specialized training, testing capabilities and isolation and quarantine methodologies.
Here's how the system could work. Concerned citizens, believing themselves or someone else to be affected, would contact the Ebola hot line. If the in-depth interview revealed that the patient was realistically at risk, the local Ebola SWAT Team would be immediately dispatched to the patient's location. The team (physician, nurse, pharmacist, technical and support staff) would be fully trained, equipped and prepared to assess the patient, including having a mobile lab to run blood tests on the spot. If it was determined that the patient did have Ebola, then the patient would be transported to the appropriate regional institution in a safe and controlled manner.
Approaching the Ebola problem is a major global challenge, and debates about controversial steps, such as mass travel bans, have begun. Vaccines and other treatments are in trial and will take time to be ready. But the disease is spreading in Africa and potentially gaining a foothold here. In addition to providing aid to the hardest hit countries, we should set up a straightforward system that would make better use of our medical resources and provide a more effective strategy for controlling an outbreak in the U.S.
Dan K. Morhaim is a physician and a member of the Maryland House of Delegates, representing District 11 in Baltimore County. His email is firstname.lastname@example.org.