The first case of Ebola diagnosed on US soil has caught everyone’s attention. And, it should. This is a test of how well our public health and general healthcare approaches are working. This case revealed a gigantic hole.
Although almost all the news stories, including this one from the New York Times, are saying that there was a failure to pass on to the ER doc the fact that the patient, who presented with fever and abdominal pain, had recently been in Liberia, I think that is a flimsy (and dangerous) excuse.
The emergency physician who treated and discharged this patient should have asked the question him or herself: “Have you recently been in Africa?” And, why not do this? Asking a simple question – particularly of a person who most likely had a West African accent is quick, free, and likely would have led to the diagnostic probability of Ebola and immediate isolation instead of discharge to a home where he possibly exposed other people to the virus. Not many things we do in medicine yield so much important information so easily.
It is not just ER clinicians that need to have heightened awareness, but also PCPs, people who work in urgent care and retail clinics…indeed everyone on the front lines of care. It we are to stop the spread of Ebola in the US, the first questions out of our mouths when we see someone with fever should be – “Have you been in West Africa recently? Or, have you been with someone who has been there recently?”
Just as in the beginning of the HIV epidemic when we learned to assess everyone for risk factors for HIV, we should consider Ebola in the differential diagnosis of patients presenting with fever no matter what part of the country we live in or what type of practice we have. Early identification and isolation are keys to stopping the spread of Ebola in its tracks.
Another weakness? The US Custom’s response
This week also revealed another weakness in our front lines of defense against this nasty disease. Several American reporters returning from East Africa reported experiencing a confused response on the part of the Customs agents who screened them. One agent even inspected the traveler’s boots instead of checking for fever. The CDC has been involved in training Customs agents and other border patrol staff. And, they have also provided all hospitals in the country information about Ebola response. Now it is time to magnify the message by engaging everyone in the “system” in Ebola prevention.
Some things we can do
Here are some simple things that can be done to improve health care response:
1. Place signs in waiting rooms advising patients and their families to report recent travel
2. Place reminders in EMRs and checkboxes on paper charts to facilitate recording of travel history
3. Include Ebola response scenarios in disaster preparedness drills
4. Have Grand Rounds and other educational seminars about Ebola
I am sure, my dear readers, you will come up with other measures that should be included on the list.
Please leave them as comments below.