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The Ebola workers who become Ebola patients

October 15, 2014

    Juliette Mullin, Senior Editor

    Nina Pham is a 26-year-old nurse who attended college at Texas Christian University and earned her nursing degree in 2010. Two months ago, she was certified in critical care nursing.

    And when Thomas Eric Duncan was admitted to Texas Health Presbyterian Hospital on Sept. 28, Pham was part of the team assembled to care for the Ebola-stricken Liberian national.

    Within two weeks, Pham had developed a fever. And by this past weekend, tests confirmed that she had become the first patient to become infected with Ebola on U.S. soil.

    Unfortunately, Pham isn't alone. Late on Tuesday night, tests confirmed that a second nurse who cared for Duncan at the Dallas hospital was also infected.

    This makes three cases of Ebola contracted outside Africa (with the third being in Spain). All three cases involved health care workers—and that's no coincidence.

    Why health care workers are more susceptible to Ebola

    Since the outbreak began in West Africa, more than 400 health care workers have been infected, and more than half of those workers have died of the fast-acting disease.

    Ebola does not spread easily through casual contact, but health care workers tend to have a lot of contact with the bodily fluids of Ebola patients, which transmit the virus.

    Care providers—especially nurses—treating patients at the end of their lives face an especially high risk because the virus replicates more rapidly as the disease progresses, according to Peter Hotez, dean of the National School of Tropical Medicine in Houston. Indeed, the three nurses to contract Ebola outside Africa all did so while caring for dying patients.

    By comparison, physicians treating patients in the ED would be less likely to become infected—despite fewer precautions—because patients in the early stages are not as infectious.

    In the Dallas cases, CDC Director Tom Frieden said that there was "a lot of variability in the protective gear" that workers used "prior to diagnosis and prior to when a CDC team was on the ground." Those variations could have exposed the nurses to the disease when it was especially infectious.

    In West African nations, insufficient resources and ravaged health care systems have put health care workers at even greater risk.

    In some parts of the continent, workers do not have the proper equipment to protect themselves from Ebola. For example, the Liberian Ministry of Health and Social Welfare says it needs nearly 2.5 million boxes of exam gloves to treat future Ebola patients, but there are fewer than 18,000 boxes in the Liberia right now.

    According to World Health Organization (WHO), the compassionate instincts of such workers may cause them to rush to aid visibly ill patients without pausing to protect themselves. Moreover, staffs are so overworked and exhausted that infection control mistakes may happen easily.

    The latest WHO data show that there have been more than 400 infections and 200 deaths in health care workers in West Africa. 

    Those deaths "deplet[e] one of the most vital assets during the control of any outbreak…only one to two doctors are available to treat 100,000 people, and these doctors are heavily concentrated in urban areas," WHO said this summer.

    CDC says it is implementing new protocols at the Dallas hospital to ensure the safety of workers caring for Ebola patients, as well as patients in other parts of the hospital.

    What CDC is doing to improve safety for Ebola workers in Dallas

    In addition, the agency has identified 76 workers who had some form of contact with Duncan while he was in the hospital. "Originally we assumed that once the person was in the hospital we should not have any more cases or patients," says CDC spokesperson David Daigle, adding, "now we've found out that we have to restart the clock."

    The workers are being checked every day for signs of fever.

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