Posted on 04/11/2025 6:04:33 PM PDT by nickcarraway
The cavalry isn't coming, but the infectious diseases are
On a November morning in 2018, a man checked into a crowded emergency department (ED) in California reporting fever and body aches. The clerk who checked him in quickly deduced that he had arrived 2 days prior from the Democratic Republic of Congo (DRC), where an outbreak of Ebola virus disease (EVD) was raging.
Confusion ensued. The patient was swiftly isolated: staff members walked him to a room while maintaining the recommended 6 feet of distance. Once roomed, however, they had difficulty locating the appropriate Tier 3 personal protective equipment (PPE) needed to safely deliver care. Per local protocol, any staff member entering the room was required to wear a Tyvek suit, surgical gown, apron, three pairs of gloves, surgical boots, and a powered air-purifying respirator (PAPR).
Even if they had been able to locate the PPE, none of the clinicians present remembered how to don or doff it -- a multi-step sequence that must be followed meticulously to avoid exposure. In the meantime, the California Department of Public Health instructed staff to maintain the patient's isolation while the state ascertained his risk of EVD. And so, the patient remained in a room for 3 hours, with frustrated clinicians on the other side of the closed door unable to initiate testing or treatment.
The patient didn't have Ebola (he had malaria). If he had, you would have heard of him because a patient with EVD in an American hospital is global news. But it begs the sobering question -- what would you do if a patient with EVD checked into your hospital? For me, as the director of disaster preparedness for Kaiser Permanente Northern California at the time, the case served as a wake-up call and a reminder that hoping for the best is not a viable preparedness strategy.
Why Worry About Novel Pathogens?
The likelihood of such an event is, unfortunately, on the riseopens in a new tab or window. Climate change, migration of biological vectors (including humans), antimicrobial resistance, and urbanization have virtually assured that novel pathogens -- recently emerged or re-emerged, high-threat pathogens, also known as "pathogens of high consequence" or "highly infectious pathogens" -- will continue to be introduced into new ecological nichesopens in a new tab or window. This increases both the risk of these infections in the U.S. and the potential for previously unseen host-pathogen dynamics.
As I write this, an outbreak of Sudan virus diseaseopens in a new tab or window has infected a dozen patients in Uganda, and a mysterious febrile diseaseopens in a new tab or window in the DRC has rapidly killed over 50 people. Closer to home, H5N1 bird fluopens in a new tab or window is making its way through various animal species, and measles rages in Texasopens in a new tab or window. Other examples include Lassa, Marburg, smallpox, Hantavirus, SARS, and the dreaded "Disease X.opens in a new tab or window"
Unfortunately, novel pathogens are hard to be prepared for. As noted, there's an extraordinary amount of highly specific PPE that must be maintained and stored in an easily accessible location. Most American physicians' experience with the clinical management of these infections is virtually nonexistent. On top of that, there's a series of complicated infection prevention protocols -- in the absence of clinical experience, proficiency with these protocols can only be achieved through regular, standardized training sessions.
And then there's the nature of novel pathogens themselves. As a group, they share multiple unsettling characteristics. They are highly contagious and infectious; there is often no specific treatment; they are associated with significant morbidity and mortality; and they understandably cause apprehension amongst healthcare workers (there's a reason Ebola is called "the caregiver's disease"). In other words, a single patient infected with a novel pathogen is a high-stakes, possibly disastrous event in any hospital.
An Innovative Approach to Novel Infections
Back in 2018, following the Ebola near-miss at one of our hospitals, I realized our organization needed an innovative approach to novel pathogen preparedness. After a multidisciplinary discussion that included infectious disease, infection prevention, and disaster management specialists, we decided to create a mobile response team of physicians and nurses specifically trained in novel pathogen management. We reasoned that a single, highly trained strike team that could be deployed to any number of hospitals to deliver direct clinical care would bypass many of the inherent challenges in novel pathogen preparedness, while simultaneously optimizing available resources (including provider bandwidth).
In 2019, we officially launched the strike team. And then we equipped and trained it for success. We assigned each team member a "go-bag" with a 3M PAPR, two hoods, and two sets of Tier 3 PPE. We required every member to attend an initial orientation session and two training sessions annually. These day-long trainings typically included a didactic portion (global outbreak epidemiology, infection prevention protocols, clinical management) and a skills/simulation portion (donning and doffing Tier 3 PPE, IV placement, or intubation while donned).
We developed checklists and workflows and made sure every member had a copy of these in their go-bag. Recognizing that novel pathogens often lead to more widespread outbreaks, we taught team members how to conduct just-in-time training in order to rapidly scale up response capability should this become necessary.
Along the way, we improved through trial and error. After our first drill, we realized we needed a notification system to contact team members. We discovered myriad human resources considerations, such as what was expected post-deployment (answer: return to both home and work with resumption of the member's usual schedule) or what to do if there was an exposure or breach (answer: individual assessment by a team of employee health, infectious disease, and infection prevention specialists). We secured compensation for team members' training time and, in the event of a deployment, travel time and time spent in deployment. We realized it made sense to deploy team members in pairs.
The venture required time and organization beyond anything I ever anticipated. In retrospect, we grossly underestimated the complexity of managing a patient with a novel pathogen; it was only through tenacity and tinkering that my organization arrived at an acceptable level of preparedness. By the end of the year, we had created a first line of defense against this rare but high-stakes scenario.
The Cavalry Isn't Coming
Public health in general and global infectious diseases in particular have always suffered from a cycle of panic and neglect. Of late, however, our nation's ability to detect and deter novel pathogens has been dealt multiple significant, if not terminal, blows. In short order, the CDC has been gaggedopens in a new tab or window and its Epidemic Intelligence Serviceopens in a new tab or window placed on the chopping block; the U.S. has withdrawn from the World Health Organizationopens in a new tab or window; and the U.S. Agency for International Developmentopens in a new tab or window has been eviscerated. In an era when novel pathogens emerge consistently and stealthily, the institutions and structures designed to safeguard our communities may fail to do so when the next epidemic threat arrives.
The take-home message is that the cavalry is not coming, but the infectious diseases areopens in a new tab or window. Every American healthcare organization should be prepared to manage a patient with a novel infection, and they should be ready to go it alone. My advice is to determine which strategy works best for your hospital (we chose to pilot a mobile team, but there are many acceptable approaches) and then begin trialing it. You will probably find, as we did, that it takes some time and tinkering to get it right. What is not acceptable is to ignore the warning signs before us.
This perspective is the author's alone and does not necessarily reflect that of any institutions or companies with which she is affiliated.
Mary Meyer MD, MPH, is an emergency physician with The Permanente Medical Group. She also holds a Master of Public Health and certificates in Global Health and Climate Medicine. Meyer previously served as a director of disaster preparedness for a large healthcare system.
Like Ebola, that flesh eating type of disease is also hard to pin down. Local radio station boss Al Kresta—(co founder with Tom Monaghan, the founder of Domino’s Pizza) near here died a few months ago.
He had lost a leg to amputation due to the “flesh eating disease” necrotizing fasciitis, and no one could identify the cut or abrasion that got it into his bloodstream.
Go check the link.
It’s all there.
The likelihood of such an event is, unfortunately, on the riseopens in a new tab or window. Climate change yada yada yada.
—
Inserting “climate change” into any scientific discussion reduces the credibility to essentially zero. Nice try but the grant money has already dried up.
This is just how the Zombie Apocalypse starts.
OMG ALL THESE DISEASES ARE OPENING IN NEW TABS OR WINDOWS OMG OMG
In 2014, Kaci Hickox, a Doctors Without Borders nurse from Maine, legally battled 21-day quarantines imposed by the states of New Jersey and Maine after returning home from treating Ebola patients in Sierra Leone.[105] “Hickox was sequestered in a medical tent for days because New Jersey announced new Ebola regulations the day she arrived. She eventually was allowed to travel to Maine, where the state sought to impose a ‘voluntary quarantine’ before trying and failing to create a buffer between her and others. A state judge rejected attempts to restrict her movements, saying she posed no threat as long as she wasn’t demonstrating any symptoms of Ebola. Hickox said health care professionals like those at the U.S. Centers for Disease Control and Prevention – not politicians like New Jersey Gov. Chris Christie and Maine Gov. Paul LePage – should be in charge of making decisions that are grounded in science, not fear.”
I remember that story. IMO, that nurse’s reaction to her quarantine was silly. Surely, she had to care for isolated/quarantined patients from time to time as part of her job. But, when it was her turn, she complained.
I once was isolated in a hospital room because the staff believed I might’ve caught a very contagious illness. (It wasn’t something as serious as Ebola.) All the doctors and nurses admitted I probably didn’t have the illness, but they were required to take precautions while waiting for test results. The results were negative, and I never complained about being isolated.
The 6 ft distance is bullshit. The former CDC Director Friedan sp was made to eat those words on national TV by Dr Sanjay Gupta. You can get it farther than 6 ft from a sneeze. It is also likely IMO the hospital probably didn’t even initially have the correct level PPE at the time.
She wasn’t the only one who had a tantrum over it.
There was another doctor who came straight from the hotzone and decided to go to the deli while having a fever and sweating.
He didn’t get as famous as Ebola Nurse because after opening his yap a few times he figured out that he was getting pretty hated.
Ebola Nurse though, she was very special.
Still has her defenders.
I don’t remember hearing about the doctor, but that nurse was a piece of work. Everyone else who was exposed had to be quarantined, but she didn’t think she should be required.
Actually, hospitals do not have protocols. When the Ebola patient landed in Texas, our hospital in WA state sent out an email about the PPE we should wear. Except, the neck, arms and lower legs were exposed. Its like they didn’t care. Even the hospital in Texas didn’t care about their staff, and a couple of nurses got Ebola due to a lack of protection protocols.. Thats why the CDC is useless, there was no screening of people coming from Africa. Thats why I don’t care why they are getting fired now under Musk , they also was useless during covid.
Well, the hospital I worked at had them. As a member of the EM team we had protocols for a binder full of scenarios. And we reviewed them and augmented them on an annual basis.
It was the most interesting part of my job there. It was scary to review ALL of the things that could happen.
I forget his name, he drew tons of heat.
But princess Kaci, yeah.
And she hadn’t followed protocol for the whole allotted time, and nobody really knows for sure what the incubation or transmissive periods are.
There were reports of a guy being cleared, gives his significant other ebola via sex yet he survived.
Ebola is a weird bug, and the whole kerfluffle with it was made even worse with the Obama administration insisting on bringing people from the hot zone straight here.
Almost like the whole point was to try and get an outbreak going.
Thankfully ebola is a crap infector outside of its home turf.
But still, breaking quarantine and then tossing a tantrum over it.
Then a couple years later they had everyone in quarantine over a bug with a 99 percent survival rate.
And instead of quarantining the sick they locked up everything.
Thats good that your hospital had protocols. I was shocked when we got the email that showed exposed body parts. But then I recalled, its a corporate soul less entity. I would walk out if I had no adequate PPE. Its too bad the nurses in Texas didn’t do that, they have had lifelong health consequences and are not practicing nursing anymore. Not my problem anymore, I am retired.
Get vaxed, boosted, masked, social distance— no problemo.
Hickox said health care professionals like those at the U.S. Centers for Disease Control and Prevention - not politicians like New Jersey Gov. Chris Christie and Maine Gov.Paul LePage — should be in charge of making decisions that are grounded in science, not fear.”
a STATE JUDGE rejected attempts to restrict her movements.. he had extensive science/health care background no doubt.
Here is more on her situation, she complied, didn’t have Ebola, and then the panic caused politics got involved, Ebola was nothing new and had been around almost 40 years at the time.
https://www.bu.edu/articles/2017/kaci-hickox-ebola-nurse/
If you work in a hospital you ARE the cavalry. Do your job, know the procedures, follow them.
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