United States Ebola Failures a Cause for Concern in Australia
THE AUSTRALIAN OCTOBER 18, 2014 12:00AM
Jamie Walker
Associate Editor, QLD
Brisbane
AT the height of the international emergency over avian influenza nearly a decade ago, John Howard was presented with a plan to close Australia’s borders. The then prime minister had been attending an exercise with state emergency services over how to enforce a quarantine and the likely fallout. One scenario involved an airline coming in, defying the stop order, filled with ill people.
As it turned out, Australia kept its airports open during the pandemic of H5N1 bird flu that reached its zenith, before flaming out in 2007. While the human death toll turned out to be mercifully low — about 150 died in eastern Asia — the chaos and fear were epic. More than 140 million birds and domestic fowls were slaughtered amid fears that millions of people were at risk. Public health officers across Australia dusted off plans to deal with a major outbreak of disease here, just as they are now doing with Ebola virus disease
Bird flu is highly contagious, but nowhere near as lethal as Ebola, which is killing seven in 10 of those infected in the red zone of West Africa. Still, worst-case modelling by Queensland Health in 2006 showed that up to 500,000 residents of the state would be infected with bird flu, 14,000 of whom would require hospitalisation, with 4000 deaths. At that time, contingencies were made for the state to commandeer hotels and use them as quarantine centres. None proved necessary, as Australia largely dodged a bullet with the H5N1 virus.
Until this week, senior public health officers were quietly confident that Ebola, though worrying, posed a low-level threat to this country because our world-class protocols, hospitals and clinicians would readily contain any outbreak.
The US experience changed all of that. The evident infection control failures at the top-tier Texas Health Presbyterian Hospital in Dallas during the treatment of a Liberian man who died of Ebola on October 8 has sounded alarm bells globally.
Two of the nurses who attended Thomas Eric Duncan, 42, were themselves infected with Ebola, despite wearing regulation protective suits, under protocols that are standard for most developed countries, including Australia.
As AMA president Brian Owler points out, the Dallas hospital is a “First World facility … you would not expect that two healthcare workers would become affected by Ebola. So I think, in light of that, people are going to be looking closely at the way the treatment was conducted in Dallas to make sure that the procedures are up to scratch.’’
There was another worrying aspect to the Dallas debacle. The second nurse to become Ebola-positive, Amber Joy Vinson, had been involved in the late-phase intensive care of Duncan, who had passed through US border control before becoming sick.
As he lay dying, she inserted catheters, drew blood and cleared away his mess. She was being monitored after her teammate, Nina Pham, 26, fell ill. But Vinson, 29, took time off and flew across the country to Cleveland, Ohio, on October 10, where she caught up with a friend, a teacher. By one account, she contacted the US Centres for Disease Control and Prevention (CDC) and asked whether she should fly home when she was running a temperature. Go ahead, she allegedly was told. Her diagnosis with Ebola the following day, after she had landed in Dallas, sparked a frantic effort to trace the 132 other passengers on the flight potentially exposed to the disease (the risk is rated extremely low).
Two Cleveland schools have now been closed as a result of contact with staff while there.
The US government is under intensifying pressure, from the public and politicians in congress, to slap travel restrictions on people under Ebola watch. There are calls for this to extend to an outright ban on people entering the country from the hot-button countries in West Africa, Sierra Leone, Liberia and Guinea. The Democratic Republic of the Congo, deep in the continent’s interior, also has been hit by a separate Ebola outbreak, though this appears to be under control, as is an early eruption in Nigeria. The Obama administration, at this point, is reported to be reluctant to close its borders to West Africans, especially when it has started to deploy the lead elements of a 3000-strong military-led relief mission to the region.
But CDC director Thomas Frieden told the House Judiciary Committee on Thursday that all options were on the table. “We will consider any options to better protect Americans,’’ he said.
To date, north Queensland MP Bob Katter has been the loudest and boldest proponent of mandatory quarantine for those who have been in the Ebola zone, including returning Australian health workers. They work in West Africa with aid groups such as the Red Cross and Medecins Sans Frontieres, not under the auspices of the Australian government, which is refusing to commit personnel on the basis that it can’t guarantee they can be airlifted out in the event of being infected.
Katter has been howled down by the AMA and other critics, but that doesn’t mean government decision-makers are not taking careful note of the discussion; Cabinet’s National Security Committee has considered the widening crisis on five separate occasions, as The Australian revealed yesterday.
The case of Cairns nurse Sue Ellen Kovack, who developed a mild fever after returning home from a secondment in Sierra Leone with the Red Cross and entering voluntary home quarantine, is not a million miles from Vinson. Kovack flew in to Perth on Sunday, October 5, and flew to Melbourne the following day before arriving home on Tuesday, October 7. She reported her elevated temperature two days later, sparking a major scare as fever is the first sign of Ebola. Thankfully, she tested negative.
The swine flu emergency in 2009 provides the precedent for stricter quarantine measures. This virulent strain of H1N1 influenza laid low more than 37,000 Australians, causing or contributing to the deaths of up to 1600 on some estimates. Cruise ships were quarantined, hotels and schools closed. The Chief Health Officer of NSW was given stronger powers to mandate that infected people stay in home isolation for up to 14 days, enforceable by the police.
Katter argued yesterday that returning health workers and others flying in from West Africa could sit out a period of mandatory isolation in holiday homes. “Anything short of three days’ isolation would be unacceptable,’’ the maverick backbencher declared.
Former AMA president Kerryn Phelps says there is a striking difference between Australia’s tough animal quarantine regulations and those for humans. “We’re really strict with livestock but we’re really slack with people getting on a plane,’’ she complains. This may gloss over the basic point, made by doctors opposed to quarantine, that animals can’t speak up if they’re feeling ill.
But Melbourne emergency physician Stephen Parnis says the priority is to ensure that anyone sick with Ebola or known to have had exposure to the virus needs to be isolated, and he has an open mind on how this can be done. Parnis, a federal vice-president of the AMA, won’t speculate on “specific measures’’, but tells Inquirer: “You would need to minimise direct contact with other people as a general principle.’’
In their weekly telephone hook-up yesterday, the nation’s chief health officers canvassed quarantine options. Jeannette Young, of Queensland, insisted afterwards there was no need for regular passengers to join health workers in voluntary home isolation or any other form of containment — provided, of course, they were well.
Since Ebola took hold in West Africa, claiming more than 4000 lives so far, 724 people had been checked on arrival at Australia airports, 11 of whom were subsequently tested for Ebola. None was positive.
“The major need is for healthcare workers because we know they have been exposed,’’ she says. “These other people have not been exposed to anyone. The risk is very, very low. It’s a matter of giving them information so they know what to look for. With that … the risk is covered.’’
Young says, however, there is merit in checking all passengers flying in from West Africa by no-touch laser thermometer, as is done at some airports in the US. But for all the reassuring talk by the experts about Australia being ready for Ebola, there was a jaw-dropping reality check on Thursday when federal Health Minister Peter Dutton toured the infectious disease unit of the Royal Brisbane and Women’s Hospital, one of three designated Ebola treatment centres in Queensland. In what was supposed to be a reassuring photo opportunity with the media, the clinical staff turned out in personal protective equipment that left skin on their necks exposed, replicating shortcomings in the PPE of the sick Texan nurses.
Owler was stunned. “The gear was clearly not appropriate … and only engenders worry,’’ he says. When he called around yesterday, the AMA chief was told that Royal Adelaide Hospital had only that morning received Ebola-standard PPE — which should include rubber boots, tear-resistant coveralls, hood, mask and face shield.
In addition, staff are to be double-gloved when interacting with a patient or suspected carrier. After all the “soul searching’’ prompted by the failure of infection controls in Dallas, Owler had expected better.
The Ebola threat to Australia does need to be kept in perspective. The disease, though terrible, is not contagious like the flu, and needs direct and probably fairly intensive contact with the bodily fluids of an infected person to be spread.
People are not infectious until symptoms emerge, generally with fever. All of this means a First World health system could and should cope. That the US health system failed the test of Ebola at the first hurdle is cause for genuine concern.
 |
| Dallas Nurse Amber Vinson is the third Ebola patient in the United States. She provided care for Thomas Eric Duncan. |
Jamie Walker
Associate Editor, QLD
Brisbane
AT the height of the international emergency over avian influenza nearly a decade ago, John Howard was presented with a plan to close Australia’s borders. The then prime minister had been attending an exercise with state emergency services over how to enforce a quarantine and the likely fallout. One scenario involved an airline coming in, defying the stop order, filled with ill people.
As it turned out, Australia kept its airports open during the pandemic of H5N1 bird flu that reached its zenith, before flaming out in 2007. While the human death toll turned out to be mercifully low — about 150 died in eastern Asia — the chaos and fear were epic. More than 140 million birds and domestic fowls were slaughtered amid fears that millions of people were at risk. Public health officers across Australia dusted off plans to deal with a major outbreak of disease here, just as they are now doing with Ebola virus disease
Bird flu is highly contagious, but nowhere near as lethal as Ebola, which is killing seven in 10 of those infected in the red zone of West Africa. Still, worst-case modelling by Queensland Health in 2006 showed that up to 500,000 residents of the state would be infected with bird flu, 14,000 of whom would require hospitalisation, with 4000 deaths. At that time, contingencies were made for the state to commandeer hotels and use them as quarantine centres. None proved necessary, as Australia largely dodged a bullet with the H5N1 virus.
Until this week, senior public health officers were quietly confident that Ebola, though worrying, posed a low-level threat to this country because our world-class protocols, hospitals and clinicians would readily contain any outbreak.
The US experience changed all of that. The evident infection control failures at the top-tier Texas Health Presbyterian Hospital in Dallas during the treatment of a Liberian man who died of Ebola on October 8 has sounded alarm bells globally.
Two of the nurses who attended Thomas Eric Duncan, 42, were themselves infected with Ebola, despite wearing regulation protective suits, under protocols that are standard for most developed countries, including Australia.
As AMA president Brian Owler points out, the Dallas hospital is a “First World facility … you would not expect that two healthcare workers would become affected by Ebola. So I think, in light of that, people are going to be looking closely at the way the treatment was conducted in Dallas to make sure that the procedures are up to scratch.’’
There was another worrying aspect to the Dallas debacle. The second nurse to become Ebola-positive, Amber Joy Vinson, had been involved in the late-phase intensive care of Duncan, who had passed through US border control before becoming sick.
As he lay dying, she inserted catheters, drew blood and cleared away his mess. She was being monitored after her teammate, Nina Pham, 26, fell ill. But Vinson, 29, took time off and flew across the country to Cleveland, Ohio, on October 10, where she caught up with a friend, a teacher. By one account, she contacted the US Centres for Disease Control and Prevention (CDC) and asked whether she should fly home when she was running a temperature. Go ahead, she allegedly was told. Her diagnosis with Ebola the following day, after she had landed in Dallas, sparked a frantic effort to trace the 132 other passengers on the flight potentially exposed to the disease (the risk is rated extremely low).
Two Cleveland schools have now been closed as a result of contact with staff while there.
The US government is under intensifying pressure, from the public and politicians in congress, to slap travel restrictions on people under Ebola watch. There are calls for this to extend to an outright ban on people entering the country from the hot-button countries in West Africa, Sierra Leone, Liberia and Guinea. The Democratic Republic of the Congo, deep in the continent’s interior, also has been hit by a separate Ebola outbreak, though this appears to be under control, as is an early eruption in Nigeria. The Obama administration, at this point, is reported to be reluctant to close its borders to West Africans, especially when it has started to deploy the lead elements of a 3000-strong military-led relief mission to the region.
But CDC director Thomas Frieden told the House Judiciary Committee on Thursday that all options were on the table. “We will consider any options to better protect Americans,’’ he said.
To date, north Queensland MP Bob Katter has been the loudest and boldest proponent of mandatory quarantine for those who have been in the Ebola zone, including returning Australian health workers. They work in West Africa with aid groups such as the Red Cross and Medecins Sans Frontieres, not under the auspices of the Australian government, which is refusing to commit personnel on the basis that it can’t guarantee they can be airlifted out in the event of being infected.
Katter has been howled down by the AMA and other critics, but that doesn’t mean government decision-makers are not taking careful note of the discussion; Cabinet’s National Security Committee has considered the widening crisis on five separate occasions, as The Australian revealed yesterday.
The case of Cairns nurse Sue Ellen Kovack, who developed a mild fever after returning home from a secondment in Sierra Leone with the Red Cross and entering voluntary home quarantine, is not a million miles from Vinson. Kovack flew in to Perth on Sunday, October 5, and flew to Melbourne the following day before arriving home on Tuesday, October 7. She reported her elevated temperature two days later, sparking a major scare as fever is the first sign of Ebola. Thankfully, she tested negative.
The swine flu emergency in 2009 provides the precedent for stricter quarantine measures. This virulent strain of H1N1 influenza laid low more than 37,000 Australians, causing or contributing to the deaths of up to 1600 on some estimates. Cruise ships were quarantined, hotels and schools closed. The Chief Health Officer of NSW was given stronger powers to mandate that infected people stay in home isolation for up to 14 days, enforceable by the police.
Katter argued yesterday that returning health workers and others flying in from West Africa could sit out a period of mandatory isolation in holiday homes. “Anything short of three days’ isolation would be unacceptable,’’ the maverick backbencher declared.
Former AMA president Kerryn Phelps says there is a striking difference between Australia’s tough animal quarantine regulations and those for humans. “We’re really strict with livestock but we’re really slack with people getting on a plane,’’ she complains. This may gloss over the basic point, made by doctors opposed to quarantine, that animals can’t speak up if they’re feeling ill.
But Melbourne emergency physician Stephen Parnis says the priority is to ensure that anyone sick with Ebola or known to have had exposure to the virus needs to be isolated, and he has an open mind on how this can be done. Parnis, a federal vice-president of the AMA, won’t speculate on “specific measures’’, but tells Inquirer: “You would need to minimise direct contact with other people as a general principle.’’
In their weekly telephone hook-up yesterday, the nation’s chief health officers canvassed quarantine options. Jeannette Young, of Queensland, insisted afterwards there was no need for regular passengers to join health workers in voluntary home isolation or any other form of containment — provided, of course, they were well.
Since Ebola took hold in West Africa, claiming more than 4000 lives so far, 724 people had been checked on arrival at Australia airports, 11 of whom were subsequently tested for Ebola. None was positive.
“The major need is for healthcare workers because we know they have been exposed,’’ she says. “These other people have not been exposed to anyone. The risk is very, very low. It’s a matter of giving them information so they know what to look for. With that … the risk is covered.’’
Young says, however, there is merit in checking all passengers flying in from West Africa by no-touch laser thermometer, as is done at some airports in the US. But for all the reassuring talk by the experts about Australia being ready for Ebola, there was a jaw-dropping reality check on Thursday when federal Health Minister Peter Dutton toured the infectious disease unit of the Royal Brisbane and Women’s Hospital, one of three designated Ebola treatment centres in Queensland. In what was supposed to be a reassuring photo opportunity with the media, the clinical staff turned out in personal protective equipment that left skin on their necks exposed, replicating shortcomings in the PPE of the sick Texan nurses.
Owler was stunned. “The gear was clearly not appropriate … and only engenders worry,’’ he says. When he called around yesterday, the AMA chief was told that Royal Adelaide Hospital had only that morning received Ebola-standard PPE — which should include rubber boots, tear-resistant coveralls, hood, mask and face shield.
In addition, staff are to be double-gloved when interacting with a patient or suspected carrier. After all the “soul searching’’ prompted by the failure of infection controls in Dallas, Owler had expected better.
The Ebola threat to Australia does need to be kept in perspective. The disease, though terrible, is not contagious like the flu, and needs direct and probably fairly intensive contact with the bodily fluids of an infected person to be spread.
People are not infectious until symptoms emerge, generally with fever. All of this means a First World health system could and should cope. That the US health system failed the test of Ebola at the first hurdle is cause for genuine concern.
No comments:
Post a Comment