When Should You Start Worrying About Ebola? MGH Doctor Breaks It Down

Panic is high in the city this week after two people in New England showed signs associated with being infected with Ebola. Boston doesn’t need high anxiety right now, it needs calm, cool advice from an expert who does not mince words. Dr. Ednan Bajwa, ICU Director at Massachusetts General Hospital, is that expert. He’s here to save us all from ourselves.

∙ A woman reportedly vomited blood on the Orange Line on Thursday, prompting an emergency call claiming the woman was both from Liberia and infected with Ebola. Neither claim was true. Do you think this was an appropriate first response?

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Dr. Ednan Bajwa, ICU Director at Massachusetts General Hospital.

“Unfortunately, while the caller clearly overreacted and made up information, I think first responders have to take a call like that seriously and respond as though it’s real. Chalk this one up to generalized fear and misinformation. Hopefully most people would take a more reasoned approach and not give false information to the authorities. Fortunately the first responders did their job very well and the situation was resolved quickly.’’

∙ Down at Yale, a doctoral student who had recently been to Liberia came down with a fever. The student tested negative for Ebola, but had low-level symptoms. Was that case a cause for concern?

“It wasn’t a major cause for concern. They knew very quickly that the student was unlikely to have been exposed based on their history, but isolated and tested them out of an abundance of caution. I suspect most physicians and public health officials really don’t want to make the initial mistake that was made in Dallas, of sending a possible case home. This situation was also resolved quickly and smoothly.’’

∙ Representatives of the area’s nursing union told the Mass. Legislature’s Public Health Committee that area hospitals were not as prepared for Ebola cases as has been reported. Federal hospital emergency preparedness funding has dropped by 38 percent, according to MGH’s Paul Biddinger. Should that make people worried?

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“The loss of preparedness funding is definitely a concerning factor overall, as any large effort to provide training and equipment is hurt because hospitals and government agencies may not have the resources to do it as efficiently as in the past. I do think the Dallas experience of having two health care workers infected has been a wake-up call for all hospitals, who should be working hard to reassure their staff, especially nursing staff, that they will be protected. I completely understand the concerns of nurses, especially ICU nurses. It’s the responsibility of hospitals to make sure the possible mistakes that were made in the past will not happen again.’’

∙ A second Dallas nurse has been diagnosed with Ebola. Just days before her diagnosis, she reportedly called authorities to report a fever and ask whether she was well enough to fly. The CDC told her to take the flight. Was that the right call? Should people on that flight be worried?

“It certainly was a big mistake from the standpoint of reassuring the public, and rightfully has led to a lot of concern. In reality the risk to the general public is very low, even to most of the people on the flight. The people sitting immediately near her might be at slightly increased risk, but even then, it’s very unlikely they would have been exposed to any bodily fluids. In addition, she was in the early stages of infection, and we know that people are much less infectious at that stage. She shouldn’t have taken the flight or been told that it was okay do so, but I would be very surprised if anyone else becomes infected as a result.’’

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∙ Given the infection of a second Dallas nurse and some of these scares in this area and across the country, has your view of the threat changed at all? Is this still something people should worry about, or is it something that’s super unlikely but should be monitored by the general public?

“I think there has to be a clear distinction made between spread in the hospital setting, and possible spread among the public. As we know from the way the virus works and the experience with the first patient in Dallas, no one in the public was infected despite several days of exposures, and even in the hospital, the health care workers infected were those who had a very high degree of exposure to infected bodily fluids. People should look at that information and be reassured that there’s nothing mysterious going on. The virus works the way that we know it works, and it’s hard for it to spread in public. The infections of two nurses is obviously very concerning, but the evidence seems to be mounting that there were mistakes made with personal protective equipment. Now that everyone is aware of these concerns, hospitals can work to rectify them and protect their staff.’’

∙ There’s certainly a lot of irrational fear about Ebola, but are there rational concerns the general public should have about the illness?

“I don’t fault anyone for being concerned and wanting to know more. I think the public has a rational interest in making sure that hospitals, public health authorities, and government agencies like the CDC are functioning the way that they are supposed to. There have admittedly been some missteps surrounding the Dallas situation, and I think as a member of the public it’s rational to be concerned about accountability and making sure that mistakes are corrected for the future.’’

∙ Are we in a full-blown panic? What can be done to bring expectations back to reality?

“I think there was an initial lull of news after the first patient in Dallas passed away, and that’s been followed rapid-fire by the news of two nurses being infected, in addition to the news of the nurse taking an airplane flight to Cleveland, and now another health care worker being on a cruise ship. Having so much news in a short period of time has obviously raised a lot of concerns among the public. I don’t think we’re in a full-blown panic yet, and I think that if we can go several days without any more news of that nature, hopefully things will start to settle down again. One thing that media organizations in particular can do is try to fairly report the actual risk that these situations pose to the public. For example, while the cruise ship situation will produce some alarming headlines, in reality the risk of spread from that person is very low because they don’t appear to have a risky exposure and they don’t have any symptoms themselves. I think the CDC and public health officials can also help calm some fears by making clear to health care workers like this what the expectations are for not traveling, monitoring their own symptoms, etc.

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