Here we go again…

The Ebola outbreak in the eastern part of the Democratic Republic of the Congo (DRC) has now surpassed the country’s outbreak earlier in the year, and officials from the World Health Organization (WHO) said they are are “even more worried” after visiting the affected communities.

At a press briefing at the United Nations in Geneva, Switzerland, WHO director-general Tedros Adhanom Ghebreyesus, PhD, said that as of yesterday, there are now 57 cases, including 30 confirmed, and there have been 41 deaths — surpassing the 53 cases and 29 deaths in the prior outbreak.

Security continues to be a major problem in this part of the DRC, with more than 100 armed groups operating in the province. Ghebreyesus said that since January, the area has seen 120 violent incidents.

“The night we stayed in Bene, there was fighting within 15 km [of us], four civilians were killed, and many were kidnapped.”

Ghebreyesus added that “red zones” — where armed groups are operating — are extremely conducive to transmitting Ebola, and that infected people in those areas may be unable to move to get the treatment they need.

In addition to security, officials also cited high population density, as well as the number of healthcare workers already infected with Ebola in the city of Mangina, as issues that are unique to this outbreak.

NOW it’s time to panic…

Ebola is threatening much of the world’s chocolate supply.

Ivory Coast, the world’s largest producer of cacao, the raw ingredient in M&M’s, Butterfingers and Snickers Bars, has shut down its borders with Liberia and Guinea, putting a major crimp on the workforce needed to pick the beans that end up in chocolate bars and other treats just as the harvest season begins. The West African nation of about 20 million — also known as Côte D’Ivoire — has yet to experience a single case of Ebola, but the outbreak already could raise prices.


Second Ebola case? That didn’t take long

A few thoughts:

1) There had to be a break in technique, but wow, the consequences are tough.

2) I wonder what the census is at Texas Health Presbyterian, otherwise known as “the Ebola hospital”?

3) While the CDC says that they are stepping up Ebola screening at airports, a Miami doctor returning from Nigeria says she was never questioned–“No one seemed to care.” When is our government going to get serious about keeping out further cases?

4) Has anyone noticed a run on bleach at Wal-Mart?

Anyway, here’s the story:

The director of the Centers for Disease Control and Prevention said a “breach of protocol” caused a health care worker at a Dallas hospital to contract Ebola.

The health care worker, a female nurse at Texas Health Presbyterian Hospital, had “extensive contact” on multiple occasions with Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., who died last week, Dr. Tom Frieden said in a press conference Sunday.

The health care worker’s case is the first known case of the disease being contracted or transmitted in the U.S. Frieden said the CDC is evaluating other health care workers who may have had the same breach of protocol as the nurse…

…Dr. Daniel Varga, of the Texas Health Resource, said the worker was in full protective gear when they provided care to Duncan during his second visit to the hospital.


No, you can’t blame this one on the EMR

I have done my share of complaining about electronic medical records (EMR), but in this case the blame is misplaced.

‘Flaw’ in Electronic Health Record Blamed for Medical Error Involving Ebola Patient

When a sick Liberian man walked into Texas Presbyterian Hospital last month, “Protocols were followed by both the physician and the nurses,” the hospital said in a statement released Thursday night.

The man told a nurse he had come from West Africa, where an Ebola epidemic is raging.

“However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case.”

The hospital said its electronic health records include “separate physician and nursing workflows.”

The hospital said the Liberian man’s travel history was located in the nurses’ portion of the EHR, but — “As designed, the travel history would not automatically appear in the physician’s standard workflow.”

Yes, EMR has turned doctors and nurses into data entry clerks, and has decreased face to face communication between members of the health care team. But you can’t blame this error on the EMR.

The physician is responsible for obtaining an appropriate medical history from each patient, including travel history and exposure history. I frequently see patients originally from Latin America, the Middle East, Central and Southeast Asia, and, yes, from Africa. Getting a travel history from these patients is always appropriate, and is the doctor’s responsibility, regardless of the nurse’s responsibility to enter it into the EMR.

One of the things I strive to teach my students and residents is “If you ask the right questions, the patient will tell you what is wrong with him.” In today’s technological world of medicine, no lab tests or imaging scans will replace performing a good history and physical examination.


It is past time for a travel ban

I wanted to write about this subject, but Joe Alton, MD has done a great job of it at Doom and Bloom.

A Travel Ban: Quick, Simple, and RIGHT

Recently, Ebola arrived in the United States when a man named Thomas Duncan stepped off a plane from Liberia. In the short time he has been in this country, he had direct or indirect contact with up to 100 people. Although every effort has been made to contain this case, it brings up the question as to whether a travel ban of flights from West Africa would have a protective effect for U.S. citizens.

The Director of the Center for Disease Control, Dr. Tom Frieden, has stated that ““If we take actions that seem like they may work, they may be the kind of solution to a complex problem that is quick, simple and wrong,”. His reasoning is that isolation of countries that have been ravaged by the epidemic would amount to cruel and unusual punishment. He also implies that needed help for these countries would somehow be hindered by restricting air travel from them. He says that the only way to ensure Americans are safe from the virus is to care for people in the Ebola-ravaged countries of Sierra Leone, Guinea and Liberia who have it.

His statements are well-meaning but go against sound logic. The restriction of air travel FROM Ebola-ridden nations and the active transport of aid TO them are not mutually exclusive. I applaud our efforts to send the best care to Guinea, Liberia, and Sierra Leone. However, a travel ban will decrease the chances of more Ebola cases here. A healthier U.S. means more resources sent elsewhere.