By the time you read this blog, there will already have been a webinar put on by the New Hampshire Department of Health and Human Services on Ebola virus disease titled “Moving Clinicians from Panic to Prepared.”  As some of you may know, I wrote about EVD a few months ago for the bimonthly NHMS newsletter and asked the question about how the spread of disease could be stopped, when healthcare workers were one of the most at-risk populations.  How could a clinician not panic, seeing how egalitarian this virus has been, having complete disregard for social or professional status as it has claimed victim after victim, spreading across continents at will.  Nursing assistants infected in Spain, a father returning to Texas to be with his son, a Rhode Island cameraman filming in the hot zone.

The rules are somewhat changed now, compared to two months ago.  The current death toll worldwide is more than 3,400.  Cremation is being used instead of burials in some countries due to the fears of the infection risk after death.  We must now think about this virus anytime we see a patient with a high fever or when we go to the airport and consider from where that person in Seat 13C just traveled.  To think I used to only be worried about taking off my shoes going through security.

Before we start building panic rooms, buying hazmat suits for the holidays (did USAID actually put out a bid for 160,000 suits?) or trading in the family SUV for a pulsed-xenon ultraviolet disinfecting robot (“honey, I told you this is the greatest bug zapper ever!”), as clinicians we need to keep those around us (and ourselves) calm, bring knowledge through education and try to stop the exponential growth of EVD.  Early recognition in any case is crucial.  Eliciting a thorough travel history within the past 21 days in patients with fever greater than 101.5, myalgia, headache, GI distress or bleeding will need to be the standard.  If suspected, a patient will need to be isolated/quarantined, and the chore of contact tracing will start.  If a case of EVD is suspected, the clinician needs to immediately contact the local or state health department.  The Centers for Disease Control has algorithms for the evaluation of returning travelers and a listing of risk-exposure levels.  Hospitals will need to prepare detailed Ebola checklists.  The treatment is usually supportive for symptoms, with consideration of experimental drugs, if available. The supply of a previously used experimental drug (ZMapp) has run out and may take two months to become available again.

In 1978, when I went to summer camp for six weeks, I took along a new book by Stephen King.  As the review said, “When a man escapes from a biological testing facility, he sets in motion a deadly domino effect, spreading a mutated strain of the flu that will wipe out 99 percent of humanity within a few weeks. The survivors who remain are scared, bewildered, and in need of a leader.”  I couldn’t put that book down all summer, all 1,472 pages of it.  The story seems a little too real to me now.

“Come on down, and meet your maker. Come on down, and make the stand

Regards,

Stuart J. Glassman, MD

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