Unprecedented number of medical staff infected with Ebola

The outbreak of Ebola Virus Disease (EVD) in West Africa is unprecedented in many ways, including the high proportion of doctors, nurses, and other health care workers who have been infected. To date, more than 240 health care workers have developed the disease in Guinea, Liberia, Nigeria, and Sierra Leone, and more than 120 have died.

In Nigeria, three health workers, Ameyo Stella Adadevoh, lead consultant at First Consultants Medical Centre; Justina Ejelonu, a nurse and another health worker have died as a result of making contact with the index case, Patrick Sawyer, the Liberian-American who imported the disease into Nigeria.

So far, the hemorrhagic fever has killed at least 1,427 people and 2, 615 cases recorded in the deadliest outbreak of the disease, according to WHO data as of August 20, 2014.

Several factors help explain the high proportion of infected medical staff. These factors include shortages of personal protective equipment or its improper use, far too few medical staff for such a large outbreak, and the compassion that causes medical staff to work in isolation wards far beyond the number of hours recommended as safe.

In the past, some Ebola outbreaks became visible only after transmission was amplified in a health care setting and doctors and nurses fell ill. Once the Ebola virus was identified and proper protective measures were put in place, cases among medical staff dropped dramatically.

Moreover, many of the most recent Ebola outbreaks have occurred in remote areas, in a part of Africa that is more familiar with this disease, and with chains of transmission that were easier to track and break.

The current outbreak is different. Capital cities as well as remote rural areas are affected, vastly increasing opportunities for undiagnosed cases to have contact with hospital staff. Neither doctors nor the public are familiar with the disease. Intense fear rules entire villages and cities.

Several infectious diseases endemic in the region, like malaria, typhoid fever, and Lassa fever, mimic the initial symptoms of the deadly contagious disease. Patients infected with these diseases will often need emergency care. Their doctors and nurses may see no reason to suspect Ebola and see no need to take protective measures.

Some documented infections have occurred when unprotected doctors rushed to aid a waiting patient who was visibly very ill. This is the first instinct of most doctors and nurses: aid the ailing. In many cases, medical staff are at risk because no protective equipment is available – not even gloves and face masks. Even in dedicated Ebola wards, personal protective equipment is often scarce or not being properly used.

On the other hand, training is absolutely essential, as are strict procedures for infection prevention and control. In addition, personal protective equipment is hot and cumbersome, especially in a tropical climate. This severely limits the time that doctors and nurses can work in an isolation ward. While some doctors work beyond their physical limits, trying to save lives in 12-hour shifts, every day of the week, staff who are exhausted are more prone to make mistakes.

The heavy toll on health care workers in this outbreak has a number of consequences that further impede control efforts. It depletes one of the most vital assets during the control of any outbreak. WHO estimates that, in the three hardest-hit countries, only one to two doctors are available to treat 100,000 people, and these doctors are heavily concentrated in urban areas.

It can lead to the closing of health facilities, especially when staff refuse to come to work, fearing for their lives. When hospitals close, other common and urgent medical needs, such as safe childbirth and treatment for malaria, are neglected.