Saturday, November 01, 2014

The Ebola Volunteer Watch Resort

Medical volunteers are desperately needed to help with Ebola patients.  But long quarantine periods are making it more difficult to get volunteers. From the New England Journal of Medicine (NEJM):

"Médecins sans Frontières, the World Health Organization, the U.S. Agency for International Development (USAID), and many other organizations say we need tens of thousands of additional volunteers to control the epidemic. We are far short of that goal, so the need for workers on the ground is great. These responsible, skilled health care workers who are risking their lives to help others are also helping by stemming the epidemic at its source.
But many people and politicians are fearful that returning medical volunteers will spread Ebola in the US.   This worry is overblown as the NEJM article also says:

"Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset. This point is supported by the fact that of the nurses caring for Thomas Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions he was shedding was likely to be very high, became infected. Notably, Duncan's family members who were living in the same household for days as he was at the start of his illness did not become infected." [emphasis added]
The NEJM argues that adding lengthy quarantine periods for returning volunteers simply makes it that much harder to recruit volunteers.

Thus, I offer an alternative:  The Ebola Volunteer Watch Resort.

 Locate or build isolated resorts where Ebola volunteers will be sent to relax and enjoy a vacation while they are watched for symptoms before returning to their home country.  The resort will offer options for various outdoor and indoor activities while the volunteers' temperatures are checked regularly.

Those who get a fever would be immediately moved to an isolated medical ward so they do not infect the others at the resort and so they can be treated. 

Volunteers could work on personal Ebola volunteer observation reports and work together with other medical volunteers to develop plans, based on their experiences, for improving the response to the Ebola outbreaks now and in the future.  This would allow Ebola medical volunteers to get some needed rest AND to have time to reflect on their experiences alone and with others and develop programs that would help with the Ebola situation and future health emergencies.

I suspect that much of the work needed does not necessarily require highly trained Western experts and that much of the volunteer work should be spent on training Africans how to do their work, thus eliminating the need for so many out-of-country volunteers.  The resorts could also be used for this sort of training.

The costs of the Watch Resorts could be born by those states that would prefer not to have Ebola volunteers return without a strictly enforced quarantine.  Or the people of those states could just read the medical literature and be more rational. 

I tend to be a skeptic about most things, including claims of medical science.  But skeptic doesn't mean rejecting out of hand.  It means asking for detailed explanations and then deciding.

The  pictures are original to this blog and are just examples. 

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