Ebola takes heaviest toll among healthcare workers

With the World Health Organisation (WHO) predicting that the three worst-hit countries in west Africa – Liberia, Sierra Leone and Guinea – could produce as many as 10,000 new cases a week by early December, the Ebola crisis continues to deepen.

The current iteration of the haemorrhagic virus is hitting healthcare workers especially hard: according to the WHO the fatality rate of Ebola- infected healthcare workers is 57 per cent. This compares with an overall case fatality rate of the 2014 West Africa Ebola outbreak of 47 per cent.

With two nurses in the US and one in Spain having contracted the virus from patients they were caring for despite using personal protective equipment (PPE) and following protocols, healthcare professionals could be forgiven for feeling a shiver of apprehension as Ebola spreads.

High concentrations

While there is continuing uncertainty about why some people with Ebola survive when others do not, we know the virus is more contagious when there are high concentrations of Ebola in the patient’s blood. The now deceased US patient

Thomas Duncan

was quite ill when he was finally admitted to a Dallas hospital, so nurses and doctors treating him were at greater risk of transmission.

Carrying out invasive procedures such as dialysis and intubation, which were performed on Duncan, place healthcare professionals at even greater risk, which has led the US Centres for Disease Control to advise the care of patients in the late stage of the disease be limited to “essential procedures”.

Source cases

The role of high viral loads in transmitting infection was reported in the 1980s when HIV was first identified. So- called “source cases” with the highest HIV viral loads were six times more likely to transmit HIV to healthcare workers.

Correctly using PPE on a continuous basis and strictly following protocols requires practice and training. It may be safer to admit patients with confirmed Ebola to designated national centres with biocontainment units where staff are prepared to look after people with highly infectious diseases.

In the Republic the designated centre is at the Mater hospital in Dublin.

There has been a noble tradition throughout history of healthcare professionals unselfishly placing themselves in the front line of infectious disease epidemics. In the 1950s doctors and nurses here contracted TB from patients. The typhus epidemics of the 1800s were also treacherous: during the period March 1843 to January 1848, 199 doctors died of typhus fever in Ireland. And some 8 per cent of medical officers appointed to fever duties in the years 1840-1846 died on duty.