Nurse Nina Pham’s Ebola Illness — Anthony Fauci’s Uninsightful Comment about an Inadvertent Breach of Protocol — the CDC’s Belated Admission that It Screwed Up — and How Managerial Complacence Leads to Being Unprepared

© 2014 Peter Free

 

15 October 2014

 

 

Reality has a way of making complacent talking heads look silly

 

Take the United States’ initially inadequate domestic response to ebola transmission.

 

When nurse Nina Pham ill with our first patient-to-provider transmission of ebola virus disease in the United States — the director of the Centers for Disease Control and Prevention (CDC) finally admitted that his agency screwed up its initial response to Thomas Duncan’s fatal illness:

 

 

[T]he U.S. Centers for Disease Control and Prevention announced Tuesday that it will send an Ebola response team within hours to any U.S. hospital that admits a patient who tests positive for the deadly virus.

 

The new teams will include epidemiologists and infection control experts who can assist hospital staffers in navigating the intricacies of Ebola patient care.

 

“I’ve been hearing loud and clear from health care workers from around the country that they’re worried, that they don’t feel prepared to take care of a patient with Ebola. That they’re very distressed that one of our colleagues now has contracted Ebola and is fighting the infection in Dallas,” said CDC Director Tom Frieden.

 

“I wish we had put a team like this on the ground the day [Thomas Duncan, Pham’s ebola patient] was diagnosed,” Frieden said.

 

Officials suspect Pham became infected through a breach in safety protocol, possibly the improper removal of personal protective equipment that she wore while treating Duncan.

 

The CDC did send epidemiologists and infection control experts to the hospital along with others who helped identify, locate and monitor 48 people who might have had contact with Duncan, after his condition was known.

 

“In retrospect, with 20/20 hindsight, we could have sent a more robust hospital infection control team and been more hands-on with the hospital from day one about exactly how this should be managed,” Frieden said during a Tuesday afternoon press conference.

 

© 2014 Tony Pugh, CDC will route response team to any US hospital with an Ebola patient, McClatchy via NewsObserver.com (14 October 2014)

 

Months of foolishly downplaying the ebola risk to American health care workers have apparently ended.

 

It has been a long road. The CDC first downplayed its response to the massive ebola epidemic in West Africa. Then it minimized the possibility of ebola making it over here and causing trouble. And finally it underreacted, when bad things actually happened in Dallas.

 

 

The Feds’ ivory tower complacence has been illustrative

 

“An inadvertent breach of protocol” is how Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases described the cause of Nina Pham’s potentially fatal mishap in getting sick.

 

While technically accurate, his phrase disregards the statistical realities that underlie the not-so-simple task of getting an infectious disease biohazard suit on and off safely. Dr. Fauci was inadvertently implying that Pham screwed up a comparatively easy process.

 

Anyone who has ever actually had to wear and remove infectious disease hazmat suits knows that getting them on and off, without contaminating oneself under real life conditions is challenging. Especially so, day after day, week after week, while under the stress of actually having to think about and care for patients.

 

Not only does the biohazard suit process take training, it takes practice.

 

Infectious disease treatment and containment is also preferably done among teams of skilled co-workers, who can keep an eye out for each other.

 

In essence, the CDC ignored the odds that something can and will go wrong, when trying to do dangerous things that:

 

(a) one has not been trained to do

 

and

 

(b) has not lived with on a daily basis.

 

Contamination-free ebola patient care is challenging, even for trained and well-practiced medical providers.

 

Médecins Sans Frontières (Doctors without Borders) announced yesterday that 16 of its staff have caught ebola and 9 have died. And those folks presumably know what they are doing.

 

Why the CDC did not recognize these difficulties, at the outset, says nothing reassuring about our federal authorities’ common sense.

 

 

Two hypotheticals

 

Assume you work in a doctor’s office. A person walks into the crowded waiting room and up to the receptionist. He says he has a fever and returned from West Africa two weeks ago. He began feeling ill about 48 hours ago.

 

What do you do?

 

Try the same scenario in a busy community hospital emergency room. Pretend that you are the triage nurse, who has the responsibility for setting the wheels of “what is to happen” in motion.

 

 

Practicing proper “ebola surprise” protocol — in these ordinary settings — is not realistically straightforward, is it?

 

In the above two hypotheticals, “we” have this newly entered contagious person on our hands, who has touched a bunch of adjacent surfaces, and whom we need to transport (or get transported) to a place better equipped to deal with him.

 

We have to immediately conjure up the least contaminating ways to accomplish this. And simultaneously avoid panicking the waiting room and our colleagues.

 

Will we have biohazard suits on hand? Trained people to wear them?

 

Not a chance, in most places.

 

This lack of preparedness is the wide-spread reality among the most developed nations in the world. Even the United States has only four biocontainment-capable hospitals, with only a handful of beds to offer in each.

 

 

Who was the CDC trying to kid?

 

You got me.

 

The dangerous physical task of getting into and out of infectious disease hazmat get-up is the key to understanding the depth of BS that our federal medical infrastructure was trying to get us to believe, when it initially discounted the ebola threat domestically.

 

Any dangerous task that requires 100 percent concentration and perfect execution is inevitably going to go wrong some of the time.

 

When we assume that untrained, unpracticed, and ill-equipped medical people are going to successfully and consistently “do” ebola containment and care, we are lying to ourselves.

 

 

The moral? — Never take Federal doublespeak at face value

 

Even the best-intended among our federal agencies’ upper echelons display a disturbing ability to ignore Reality, when it suits them.

 

What is refreshing (today) is that CDC Director, Dr. Tom Frieden, took meaningful responsibility for his agency’s obvious mistake. That’s a first and one that is worthy of respect.