Public Health Perspectives

Hi all i have been trying to jump into discussion about ebola on a few different topics now but largely the questions that a lot of you have are around the same issues.
A bit about me first - i work in public health epidemiology, lots of people dont understand what public health is but it basically comes down to anything that has a health impact on a group of people is our responsibility. This ranges from Environmental Health issues such as chemical spills, population, what happens to decaying bodies in cemeteries, water supplies, climate change and a million other things that you wouldnt think needed monitoring. Another function of what i do is Infectious Diseases which is more straight forward and can be things like rabies prep and pep, tropical and emerging diseases, Influenza surveillance and currently Ebola.
I thought i would open this thread for people to ask questions. Can be about ebola of public health in general and ill do my best to answer. A great part of my job is that i get dedicated research time to stay up to day with whats going on in the world of public health so if you have a question i cant answer i will gladly spend time at work looking in to it for you and this way we all learn something.
Take the opportunity or not its up to you, i wont engage with people if they are being aggressive in anyway. I love a great conspiracy which is why i have lurked on this site for most of the last decade and finally decided to make an account. I appreciate differing opinions as i feel that is the only way we actually learn is if we challenge each other with our knowledge.

a reply to: D4rcyJones

In light of the CDC's problems dealing with this, what is being done to deal with the obvious un-prepared for problems we are being told about daily ᤾??

a reply to: rustydog

I should have pointed out i dont work in America, im Australian however most of our guidelines come from you guys... unfortunately for you its less trial and error then it is a baptism by fire. Im happy to talk about CDC procedures but keep in mind that it might not be entirely correct.

It boils down to as you say unpreparedness and unfortunately there are going to be problems that are unforeseen and will only be identified and solved once they happen. Consider that in the US like most western countries there is a generation of Doctors and Nurses who entered the profession without ever considering the risk that infectious disease like this would be a reality for them.This is the rocky ride you are on while everyone finds their feet.

Currently i think there is an issue around PPE and was is appropriate. The recommended PPE is sufficient to stop Ebola transmission. However i know there is talk in my area that we should use above what is needed.. this has both its pros and cons. For the time being i suspect that PPE will stay the same until either there is evidence to suggest its not working or if health unions simply refuse to work unless given different gear.

Everyday there are discussions about what is happening and why, its a slow and frustrating process. I received case notes from the Dallas case only this week and we have started going through them to see what you guys have done and how we can do it better. I suspect that it was is happening all over the US, as cases come and problems happen so to will solutions. I have complete confidence in your healthcare sector to get it under control.

Speaking broadly the situation in Africa is out of control but not because we dont know the solution, it is simply a logistical nightmare to deal with.. they need man power and until that happens its going to continue to get worse.

Edit: I think something that will come out of the investigation into the nurse contracting Ebola will be why the treating team had him on dialysis and was intubated, these are aerosol generating procedures and considered high risk. Im not sure what your guideline in US is regarding AGPs (will look into it tomorrow) but here is Aus it basically comes down to senior doctor to weigh the risk of patient dying because they didnt receive the procedure and the risk of the dying from Ebola.. It certainly not encouraged that AGPs would take place unless the hospital is fully equipped for that level of safety, which the Dallas hospital wasnt.

Here is my problem with what is happening with the current Ebola outbreak. Up to this point every Ebola outbreak over the years was able to be contained fairly easily at a "local" level or at least to a small area of a country for the most part. This current outbreak has been like a runaway dump truck slowly gaining speed until it is out of control and crashes (and it IS out of control at this point). My issue is that we (society as a whole) have pretty much ignored what was happening in Africa (as we normally do, IMO) to the point that we are risking a pandemic of global size.

What I am realizing at this point is that IF this outbreak would have been airborne from the start we would pretty much have a global pandemic at this point and mass chaos all over the globe. The events in Dallas over the last few weeks have shown just how little we can control what happens and how ill prepared the CDC was. The patient "zero" has managed to infect 2 nurses that were treating him. If that can happen here in America where we have the best minds and technology AND the virus is not currently spread via the air then it proves to me that we have no idea what we are doing. American hospitals have no idea what to do with Ebola and the CDC has failed miserably to this point in protecting the workers trying to save people with Ebola. It appears to me that the CDC was operating under the concept that Ebola would not be able to get here....epic fail that COULD have deadly consequences for us all. We were unprepared, its that simple. The CDC and US government has had how long to prepare for a pandemic that we know is coming eventually? If this had been airborne we would have global chaos on a scale we have not seen before. Scary, just plain scary.......

a reply to: BugOut
Pandemic planning is really difficult to do in advance as each agent and each outbreak is always slightly different.. it would be great if all influenza was the same and 1 vaccine did the job unfortunately every year its different and acts differently meaning that plans are rushed as information starts flowing.
Regarding previous African outbreaks, they have always been in relatively isolated areas and not in major cities and transport hubs also never on the west coats, yes the US is dealing with it for the frist but so is the west coast of Africa. Had this outbreak been in an area that had previously experienced it then things might have been better.
Western countries have long neglected emerging diseases in the developing world, the WHO is constantnly appealing to goverments for money and resources but governments tend to only look to other countries when there is a war to be had. My local medical research has lost millions in funding and i think i recall the CDC losing half its funding? The problem is lack of government leadership and willingness to provide humanitarian assistance until its becomes a problem for them.
I think you are too quick to dismiss the US ability to handle it.. when patients were treated at the designated hospitals there were no accidents everything went fine no ebola spread, its only this time in a non designated hospital that things have gone wrong this shouldnt be surprising. What is surprising is why he wasnt transferred this would have been a local decision by the hospitals treating team and staff, CDC would not have made the decision and im sure would have facilitated transfer if requested. The hospital also used high risk procedures - unfortunately i think is a case of the treating team going into 'hero' mode and not recognising their limitations.