Stopping the spread of Ebola

Former Plymouth physician weighs in on efforts

With Ebola showing up in the United States, a former Plymouth emergency room physician has taken to the airwaves to speak about the efforts to stop the spread of the disease.

Dr. Tom Combs spent more than 20 years working at North Memorial Hospital and personally dealt with the protocols involving acquired immune deficiency syndrome (AIDS) and severe acute respiratory syndrome (SARS).

To obtain Combs’ perspective on the latest disease troubling the nation and the world, numerous media outlets have interviewed the Plymouth resident, including WCCO Radio in Minneapolis, WIBC Radio in Indianapolis; WSYR Radio in Syracuse, New York; and PowerTalk 1210 in Tucson, Arizona; as well as the nationally syndicated show, “Wall Street Journal This Morning.”

Below are Combs’ thoughts that he shared with Sun Newspapers on Oct. 17.

Q: How do you feel about current protocols for international and domestic flights and overall strategy for containing the epidemic? 

A: I am beyond concerned and have been working for months to educate others in hopes that policies will change. I have not been successful.

The Ebola containment strategy in West Africa remains grossly inadequate.

The lack of an aggressive, medically sound quarantine/flight restriction of those seeking to exit the West African countries in which the disease is rampant is unfathomable. No individual should be able to board a plane from a source country for anywhere until they have spent 21 days in quarantine or can otherwise be proven to be zero risk.

The current and past “screening” process (temperature check and questionnaire) is fundamentally flawed. Infected individuals can be without symptoms for up to 21 days and questionnaires yield false responses both by intent and lack of awareness. The screening is ineffective and it is tragic that it has been relied upon to halt the spread of this disease. The Dallas patient has proven the inadequacy of the current policy. There is too much at stake to allow this to continue.

Quarantine/containment is the fundamental strategy in containing an epidemic. It is the only immediate, effective barrier to preventing worldwide spread. Restrictions must be instituted, not just for travel to the U.S., but for all destinations. Imagine the challenges if any other countries become sites of a significant outbreak – devastating.

The inadequate response is not only that of the CDC, but also the World Health Organization and the U.N. The lack of flight restriction continues even now.

A simplistic analogy is that we are running about placing buckets to catch the water that is dripping through the ceiling but we have not repaired the hole in the roof.

The comments by officials that quarantine/restrictions would unavoidably harm treatment efforts and extend the epidemic in West Africa are not true. No doubt the logistics, costs and execution of quarantine will be difficult and expensive. The impact of failing to contain the epidemic will dwarf whatever effort is required. With an appropriately directed effort, West Africa will be best served as will the rest of the planet.

Coalitions are formed to battle international threats as is occurring in the Mideast currently. I believe, with informed leadership, an international coalition can be formed to face our common lethal enemy. Our interests are totally aligned.

Tremendous resources will be required to control this disease. Timely response is essential and we are far behind. Extension of the epidemic to another country is a failure for all on the planet. Quarantine/containment efforts must not be discarded because they are logistically or politically difficult. It will not be easy, but it must be done.

Q: Are current U.S. screening processes effective? 

A: The word ‘screening” is somewhat misleading due to the realities of the up to 21 day asymptomatic incubation period (or individuals actively obscuring signs – e.g. Tylenol for fever — and the ineffectiveness of questionnaires.

I believe it is worth doing, but it is not a true safeguard. It is more akin to pouring a bucket of minnows through a screen with a mesh that catches only the biggest of the fish (“screening” in Africa) and then pouring the minnows through the same screen days or hours later (“screening” the U.S.). You may catch a few more that have “grown,” but the asymptomatic minnows (no temp or taking Tylenol and know how to “pass” the questionnaire) will pass through once more.

These realities reinforce how crucial that quarantine/containment at the source (West Africa) remains. It is the essential first step for protection.

Q: Should the U.S. develop specialized referral hospitals for Ebola patients?

A: Yes.

My career spanned the establishment of the system of designated hospitals as trauma centers. These specially equipped and staffed hospitals are designated for care of all significant trauma. The concentrated expertise, resources and experienced manpower have improved care for trauma patients with lives saved and outcomes improved.

The same rationale applies directly to ebola with the added benefit of concentrated infection control and centralized opportunity to improve care and research treatments. All hospitals need to recognize possible Ebola patients, protect themselves, isolate the individuals and effect transport to regional centers. These steps require paramedics, specialized transport and more. Protection of our dedicated health care workers is/will be essential. I believe designated centers would be safer for healthcare workers and better for patients. Let us hope that they are not needed. Quarantine of the source countries is the initial step to decrease the likelihood of more patients.

Q: What are your thoughts on the Dallas health care workers that have contracted Ebola?

Tragic and I truly believe could have been avoided by efforts at quarantine of Liberia. Restrictions would have prevented the Dallas patient from getting on a flight. I hope and pray that they will recover. Nurses are special people and do noble work. It seems so terribly unfair that these two caring people have been struck with this illness.

Q: Anything to add?

A: This challenge is not about ideology, politics, nationality, ethnicity or short term economic concerns. It is about biology.

This is a biologic war and we must win. Quarantine/containment of the disease is step No. 1.

Contact Derek Bartos at [email protected]