An American nurse is infected with a deadly disease while working in her own hospital.  Accusations of breached protocols and changing guidelines.  Too much of a hazmat suit is not a good thing.  Taking off the personal protective equipment the wrong way may kill you.  The virus is the enemy, people, don’t forget that.  What a crazy three days it has been.  Now a second healthcare worker has tested positive for Ebola.  When the executive director of a national nurses union says that she and her members are deeply alarmed about the lack of protocols at Texas Health Presbyterian Hospital, a new day has truly dawned.  Of course, the next 10 blogs could be about Ebola virus disease, but the hidden question may actually be whether physicians, now faced with a possible mortal risk in going to work while likely being employed versus being independent contractors, may consider the possibility of unionizing.  See the CNN article.

Section 7 of the National Labor Relations Act of 1935 allows for private-sector employees to collectively bargain with their employer.  However, independent contractors do not have the same rights as employees and therefore can’t really unionize or participate in collective-bargaining options.  Back in 1974, there were almost 55,000 physicians who belonged to labor unions.  Could doctors decide to go on strike now, rather than put on a hazmat suit?  Food for thought for sure.  See the articles in Yahoo!News and CNN.

The World Health Organization is predicting 10,000 new Ebola cases per week in Western Africa by December 2014.  Currently, the United States has only 13 beds designated for specific Ebola care in four major biocontainment units.  Those numbers don’t add up.  Tensions between healthcare systems and healthcare workers will likely increase as the risks for morbidity and mortality grow exponentially.  Welcome to the brave new world.  Get those union dues checks ready.  It may save your life.  See The New York Times article.


Stuart J. Glassman, MD

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Politicians and Public Health officials from the state and national levels continue to say that every hospital in the US is prepared to handle a potential patient with Ebola. What are they smoking?? If a large tertiary care hospital in Texas could not prevent it's nursing staff from becoming infected do we really expect we can do better. That is pure delusion. It is time the medical community spoke truth with the public and said we are not prepared and we need to invest resources to develop protocols for rapid identification of cases so they can be rapidly isolated and transported to trained tertiary centers for definitive care. To think that a small rural hospital could treat such an illness is a recipe for rapid spread of the disease.

I agree with your comments regarding the distraction of all the finger pointing, when the problem is a virulent virus that we are not familiar with. Do you know the status on the Boston Medical Center biochemical containment unit? It's supposedly is all dressed up with nowhere to go, I heard held up in red tape. That would, ostensibly, be a good referral facility for this area. Thanks, Elisabeth

Hopefully calm voices are looking at ALL the options from prevention of entry of Ebola into the US to prevention of spread when it does. This may need to include quarantines for US citizens rentering from high risk areas and consideration of refusing visas to non US citizens from moderate to high risk areas. At least until we can get the virus under some semblance of control. Having protective equipment and using it correctly is just one issue (And a very big one if you have ever tried to the protective gear). What about ambulance transport downtime and decreased capacity when ambulances have to be decomntaminated after each suspected case is transported. And body disposal techniques and facilities able and willing to do that. And staffing requirements and bed availability (how many beds will be out of commission ie floors designated Ebola only)during flu season? This is a challenge we can take on and win but pointing fingers at a particular hospital to say they didnt follow protective equipment protocol distracts, falsely reassures (Oh we wouldn't be that lax!), divides and weakens us when we need to focus on the big picture. There are too many vulnerable,capacity limnited weaknesses and choke points we have in all our systems as great as they are. Thanks for continuing the dialog.

The death rate in the Black Death in Mediaeval times was very similar. The opening of travel routes started it... We have airports as corralling places.. We have to learn dignity about our fear. Doctors are not going to be the first in line to see and greet patients...with a fever and malaise...We have to engage the TSA, the Police, EMT's etc...State Safety Departments have to work hand in glove with our Public and Private Health at every level... all the way down to STREET neighbourhoods. Also, as in the Black Plague other illnesses will be popping up.. here in NH we have EEE. We have immigrants from deadly war zones with other Tropical Illness like Malaria living... Our education is essential... We need a special meeting /webinar like the Ebola one, which was excellent, but did not talk to a State wide plan... We need to have a fever floor... there is no time to build a Fever Hospital...and we need to have observers teaching and watching us don and remove the hazmat suits... Again we need to leave the ivory tower and get involved...