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.
Other people had to quarantine, but she thought she was special.
I stopped reading when it mentioned climate change.🙄
That has nothing to do with the point of my comment, which was the idiocy of her opining that only health care professional grounded in science should be in charge of making decisions when it was a State Judge who rejected attempts to restrict her movements, saying she posed no threat..
She did quarantine and was cleared.
“Hickox, 33, a volunteer nurse with Doctors Without Borders, had been stopped at Newark Liberty International Airport when she returned to the United States on October 24, 2014. She was quarantined in a tent outside a New Jersey hospital for three days, even though she had no symptoms of Ebola. New Jersey agreed to let her go home to Fort Kent, Maine, a small logging town near the Canadian border.”
She had a fever when she landed in Newark. She tested negative for Ebola, but it can take time for the virus to be detected. She was supposed to quarantine for 21 days. After three days at a NJ hospital, she was sent to Maine where she was supposed to finish her quarantine at her home. But, when she got home, she refused to quarantine or stay away from other people.
It was a circus created by politicians, including Christie.
She had a fever when she first landed in Newark. She tested negative for Ebola, but an early test is no guarantee that someone doesn’t have the illness. She was supposed to stay in quarantine for 21 days. She spent three days in NJ, and then she was driven to Maine which also had a 21-day quarantine. She was expected to spend the remainder of her quarantine at home in Maine, but she refused and filed a lawsuit. A judge ruled she did not have to quarantine, but he ordered that she must be monitored.
See my post #28 above. I never complained when I was isolated for a suspected illness and then tested negative for it. Many people are isolated after they are exposed to an illness. This woman is a nurse. No doubt she at times insisted patients stay in isolation. When it was her turn, she had a meltdown. She was lucky it turned out she wasn’t ill, and so was everyone else.
The first case of Ebola in NYC was a doctor who’d returned from West Africa. He traveled around the city, and he never had any symptoms - until he did. Then, he and everyone in close contact with him had to be quarantined: https://www.reuters.com/article/world/doctor-who-worked-in-africa-first-ebola-case-in-new-york-city-idUSKCN0ID0FC/
She didn’t have a fever, the oral thermometer proved that, she had zero symptoms and tested twice a day, she was not doing anything outlandish.
To: Darksheare
“”””Kaci Hickox went out of her way to try and spread it””””
Not really.
12 posted on 4/11/2025, 7:17:12 PM by ansel12
The forehead thermometer showed a fever at the airport. She’d just returned from treating patients with Ebola. She should have stayed in isolation voluntarily.
The infrared showed a slight elevation and she said she was just flushed so they actually took her temperature and she had no fever and then she went into into quarantine.
But she’d just returned from taking care of patients with Ebola. She should’ve wanted to quarantine as a precautionary measure. The doctor in NYC was sure he didn’t have it, either, but he did.
She did quarantine, and the new quarantine guideline was issued the day she arrived and she was going to be the first, she had returned from there and was an expert with Ebola herself, as your doctor described her, “no one has recognized the fact that she’s an EIS [Epidemic Intelligence Service] expert, she’s a CDC-trained fellow … one of the most well educated people you can get in public health and at the same time, she’s someone who’s committed her life to responding. So whether or not you agree with what she said, really what she stands for is all in line with sound public health principles.”
As you keep obsessing over this do you really agree with the statement that she “””went out of her way to try and spread it”””?
I’m not obsessed with that case. I was responding to another freeper. Then, when you posted to me, I started responding to your posts.
I never said she “went out of her way to try and spread it.” I said she refused to quarantine.
You and I are never going to see eye to eye on this case. But that’s okay. No one here agrees on everything.
I might have agreed with you, if I hadn’t been placed in isolation myself a few years before Ebola. As I posted earlier, I once was isolated while waiting for negative test results. One doctor said, “We know you don’t have [the illness],” but they were required to take precautions. I understood. I didn’t complain or start talking about my constitutional rights. That’s why I see the story differently.
Yes, I pointed out to you that she had quarantined, and then you started with the fake fever business.
You seem pretty obsessed with it.
I’m not the one who’s obsessed. :-)
If you hadn’t posted to me, I would’ve forgotten about this thread.
I already explained she was supposed to quarantine for a longer period. That’s a fact.
I also said she tested with a fever at the airport. That’s a fact.
But we don’t have to agree. Have a good night.
You and that fever thing, she didn’t have a fever, that alone shows your obsession.
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