Ebola Report: Just What Happened in Spain?

UPDATE: DailyMail now reports nursing assistant is Teresa Romero Ramos, and that she is under military guard while in isolation. Authorities in Spain also are planning to euthanize Ramos’s dog as a precaution.

By Sharon K. Gilbert

[A]s the numbers of the dead and dying continue to climb in West Africa, new cases are being reported outside of Africa. Thomas Eric Duncan lied his way onto a series of airlines to hop from Brussels, to Washington D.C., and finally to Dallas. One might make an exception for Duncan; he merely wanted to make it to Texas so he could propose to Louise Troh, but now we hear of a nurse in Spain who has tested positive for Ebola.

CNN reports[i] that Teresa Romero Ramos, nursing assistant who contracted Ebola while caring for two missionary priests has been placed in isolation along with two others: Ms. Ramos’s husband and a second nurse who is exhibiting symptoms consistent with Ebola Virus Disease (EVD), however the second nurse has not tested positive for the virus. However, the second nurse does admit that she was exposed to the virus while wearing protective gear.

Protective clothing (Personal Protection Equipment or PPE) is all that stands between a health care worker (HCW) and Ebola infection. In a hospital setting, under ordinary circumstances, nurses and nursing assistants routinely use ‘universal precautions’ to reduce the risk of cross-contamination and personal exposure to pathogens. However, as strict as the ‘universal precautions’ protocol is, it is insufficient when dealing with a BSL-4 level virus such as Ebola. In Spain, while caring for the Ebola victims, all healthcare workers involved should have been give special training and observed a higher level of precaution. PPEs are vital to this protocol.

According to reports early this morning, the World Health Organization is also asking ‘what happened in Spain’. A report from this morning’s online edition of The Guardian[ii] said this regarding the incident in Madrid:

Staff at the hospital where she worked told El País that the protective suits they were given did not meet World Health Organisation (WHO) standards, which specify that suits must be impermeable and include breathing apparatus. Staff also pointed to latex gloves secured with adhesive tape as an example of how the suits were not impermeable and noted that they did not have their own breathing equipment. [emphasis added]

It’s unclear at this point, just who is responsible for PPE suits that fail to meet standards. This author won’t be surprised if someone at Carlos III Hospital loses his/her job soon. That would be a shame, because Ebola is not the kind of pathogen most HCWs encounter even once in their lives. But, there is another problem that even the most prepared hospitals may soon have to face: a dire shortage of PPE clothing.

NPR’s ‘Morning Edition’[iii] today posted an interview between hosts Steve Inskeep and Rachel Martin and guests Jackie Northam and Massoud Javadi. In that interview, Northam states that:

Doctors Without borders says it has about 25,000 protective clothing kits in each of its half-a-dozen clinics spread across Liberia, Sierra Leone and Guinea – about a two-month supply. But the Centers for Disease Control says the number of Ebola victims is increasing exponentially and could reach tens of thousands by the end of the year. That’s created a surge in demand for the PPEs. Dupont, a major manufacturer, says it has recently tripled its production. Kimberly-Clark has also increased production, says Judson Boothe, the company’s senior product supply director.

All this is good news for companies like Dupont and Kimberly-Clark, but eventually run low or even out—particularly if the estimates for rate of infection released by WHO and CDC prove accurate. According to their report, the world could see as many as 1.4 Million cases of Ebola by end of January 2015. With a death rate from 50-90 percent, that would mean about 700,000 dead—and that’s on the conservative end. Hopefully, the healthcare provided in more modern cities would find a slower rate of infection, but we are certainly off to a bad start if the Dallas and Madrid responses are any indication.

Let’s pray that the monstrous filovirus called Ebola doesn’t enter into our lexicon as synonymous with plague and Spanish flu.



[i] http://www.cnn.com/2014/10/07/world/europe/ebola-spain/index.html

[ii] http://www.theguardian.com/world/2014/oct/07/ebola-crisis-substandard-equipment-nurse-positive-spain

[iii] http://www.npr.org/2014/10/07/354230895/ebola-protective-suits-are-in-short-supply