The Ebola virus disease epidemic in West Africa has been a persistent topic of medical and public conversation over the past months. As the number of cases continues to rise, many of us undoubtedly wonder ‘What can be done?’ or possibly, ‘Is there any help that I can offer?’ With the help of content experts, we put together this message to provide Fellows with some practical information about this disease, your options for helping should you wish to, and the role of the Royal College. We have also provided links to resources where you can learn more about the disease and its implications.
Dr. Robert Fowler, FRCPC, has worked with the clinical team for the World Health Organization in the West Africa Ebola virus disease outbreak and is a Fellow of the Royal College. He participated recently in an information session with us in which he provided an update on the current status of the outbreak and offered a number of engagement mechanisms for Fellows and members to consider. In this message, I provide a summary of our discussion with him.
First, let’s situate Ebola and establish the scope of the outbreak.
This is the first Ebola virus disease outbreak in West Africa and has become the largest the world has ever experienced. Although its origins lay in rural Guinea in late 2013, the outbreak was recognized only in March 2014. Since that time, it has spread throughout West Africa; Guinea, Sierra Leone, and Liberia have been the hardest hit, while Senegal and Nigeria have had small outbreaks due to imported cases and have had no further cases reported during the past 21 days.
As of this publication date, the United States has had two imported cases, and two health workers have since tested positive for subsequent infections. There is an epidemiologically distinct outbreak in the Democratic Republic of the Congo. A number of countries have received repatriated health care workers, who have had either exposure or illness, in order to provide medical care.
As with many prior outbreaks – SARS, MERS and pandemic influenza – the Ebola virus disease conjures fear in the general public, and often considerable apprehension for us as providers of healthcare. This is natural. There is a historically high mortality rate, no specific antiviral medication, and importantly, most of us have never treated a patient with Ebola.
As to how an individual can avoid getting Ebola, a number of points deserve emphasis.
First, the mechanism of transmission is person-to-person, through direct contact with the bodily fluids of someone who is symptomatic to another person’s mucus membranes – eyes, nose and mouth – or rarely, through percutaneous exposure with a sharps injury. Ebola is a febrile gastrointestinal illness. Symptoms can occur two to 21 days after exposure, with fever, fatigue and myalgias, which progress to nausea, vomiting and diarrhea. If someone does not have symptoms, they are not considered infectious to others. Because symptoms are non-specific, a travel history (to West Africa) and contact history (to those symptomatic, to funerals) are important to solicit.
Using standard (excellent hand hygiene) and contact precautions when providing medical care to symptomatic individuals (use of gloves, a mask, goggles or a face shield and a gown) and strict adherence to infection prevention and control practices including donning and doffing personal protective equipment, you can prevent person-to-person transmission. These are the same standard and contact precautions we should take every day in caring for potentially infectious symptomatic patients. You cannot get Ebola from talking at a distance with someone who is infected – it is not “airborne” unless aerosol-generating medical procedures are performed.
You may find the following articles informative: “Caring for Critically Ill Patients with Ebola Virus Disease: Perspectives from West Africa” published in Critical Care Perspectives; and “Doing Today’s Work Superbly Well – Treating Ebola with Current Tools” published in the New England Journal of Medicine.
A case of Ebola is possible in Canada.
Yes, it is possible that health care providers and hospitals in Canada will provide care for either a health care worker from West Africa or, potentially, a traveler who subsequently develops symptoms after arrival. Health care providers and public health systems are preparing for this. To help here at home, we should all be aware of the symptoms, seek contact and travel history for Ebola for individuals with fever and/or gastrointestinal illnesses and contact the right people – your hospital infection prevention and control officer or the public health authorities in your area – should you suspect a case (www.phac-aspc.gc.ca).
How can Fellows help?
West Africa cannot begin to cope with the overwhelming burden they are facing without help from the international community and some Fellows are no doubt wondering what they can do. Without our help, the outbreak there will not soon be controlled and will pose an ongoing threat for other regions. West Africa desperately needs more clinicians to help safely treat patients with Ebola. In Guinea, case counts remain high and there are active treatment centers in many locations. In Sierra Leone and Liberia, there continue to be more patients than beds in Ebola treatment centers. With excellent supportive care, patients with Ebola can survive.
Due to an incredible humanitarian response over the past weeks, many treatment centers have been constructed. Now government and non-governmental organizations need clinicians to help local health workers provide care. Many groups are leading and assisting in the fight against Ebola. Please consider applying to help through the following organizations.
- The World Health Organization (WHO) is seeking physicians and nurses, infection prevention and control experts, epidemiologists and others to assist country WHO offices in the Ebola response. Apply here.
- Médecins Sans Frontières (MSF) is an international medical relief organization providing medical care in Ebola treatment centers in West Africa. Apply here.
- Canadian Red Cross is currently seeking clinicians and others to work in Ebola treatment centers in West Africa. Apply here.
- International Medical Corps is a global humanitarian alliance seeking Emergency Response Volunteers for the Ebola epidemic in West Africa. Apply here.
Our role: Information sharing and leveraging our simulation-based training resources
As the situation continues to unfold, the Royal College will continue to explore, with other national medical organizations, further means of assisting those affected by Ebola. On October 17, 2014, the Royal College Council discussed Ebola and recommended that at this time, our organization 1) Play an active role to source and provide accurate information to our membership and 2) Leverage our simulation-based training resources to support learning for frontline health care professionals.
On October 20, the Royal College attended a joint meeting with the Pan-Canadian Public Health Network Council and the Council of Chief Medical Officers of Healthhosted by Dr. Greg Taylor, FRCPC, Chief Public Health Officer. Along with other provincial and national public service and health care organizations, we have been asked to provide feedback on Ebola guidelines developed by Health Canada. Dr. Susan Brien, FRCSC will represent the Royal College on this team at future meetings; a follow-up teleconference is scheduled for October 30. We will provide information to our membership as it becomes available.
Regarding Council’s second recommendation, the Royal College’s Practice, Performance and Innovation (PPI) Unit has experience in developing simulation-based training have been used in the past for managing infectious-disease outbreaks, such as SARS in 2003 and MERS in 2014. Dr. Susan Brien, director, PPI has reached out to our accredited simulation partners to invite them to partner in developing simulation-based teaching resources about how to contain the virus while protecting the health of frontline workers and the public. We’ve had positive responses to date and will partner with all stakeholders to share more information as plans are developed.
In the meantime, I would be pleased to hear from any Fellows who have made contributions or who have constructive suggestions about how the Royal College can provide further support. Use the blog comment function below to share your thoughts and ideas.
Warm wishes and kind regards,
Andrew Padmos, MD, FRCPC, FACP
Chief Executive Officer