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Ebola: CDC Guidelines for Workers were Inadequate until Tuesday


CDC guidelines for health care workers in how to dress when treating an Ebola patient turn out to have been too lax, and were suddenly changed on Tuesday.  The new guidelines involve a hood to protect the neck area, two pairs of gloves, and rubber boots as well as a rubber apron.  In addition, dressing and undressing is to be individually watched by a supervisor, who ensures proper procedures are followed.  These precautions may be adequate for workers.

They do not, however, include spraying with bleach or chlorine during removal of protective gear, which is done by Doctors Without Borders in West Africa.  Respirators are also not recommended as they do not improve safety and cause claustrophobic reactions.

Additional information that has leaked into the New York Times: the Ebola patient who was admitted in Dallas after flying from Liberia had diarrhea on presentation on September 28.  This condition made transmission of the virus all the more likely, especially if the health workers did not have dedicated shoe protection, which apparently was the case initially.

Just how infectious is Ebola?  Apparently, only modestly so.  It is not contagious, that is, it is not transmitted through airborne means.  Body fluids and excreta are highly infectious, as is the skin of a deceased patient (noted in the preparation of corpses for burial, which involved extensive contact.)  The main fear of Ebola relates to its high mortality rate (50 to 70 percent) and its florid signs (vomiting and diarrhea, frequently bloody, and blood seeping from orifices) after an incubation period of a week to three weeks, rather than its being easily transmissible.

We will soon (in the next three weeks) find out just how easily Ebola can be transmitted, because of the third Dallas patient’s airplane flight with a low grade fever, the night before she became really ill.  Based on the information we have received about the poor infection-control procedures followed at the Dallas hospital where the first patient was treated, we can guess that the virus was transmitted through diarrhea contaminating the worker’s shoes.  Thus, the other airplane passengers are unlikely to become ill (we think.)

Today we feel less concern about Ebola virus infectiousness.  We could easily be wrong, and only time will tell.

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