There’s a thing you learn, when you’ve been writing about infectious diseases for a while: People love drama. They’re not so much with detail.
Drama is H5N1 avian flu killing half the people who contract it, and the enormous surge in whooping cough, and the sinister movement of almost-untreatable NDM-1 resistance from South Asia to the West.
Detail is the question of whether health care workers treating pandemic-flu patients should expect viral spread for 3 feet or 6 feet; and why immunity conferred by the current pertussis vaccine fades a few years earlier than expected; and how hospitals can encourage their janitors to clean rooms more thoroughly, when they’ve always treated them as a disposable part of the staff.
All of those details are crucial to controlling those diseases. All of them are also research questions. None of them, guaranteed, have gotten the attention or funding that would answer the questions in a way that equips us to counter the dramatic problems.
I mention this, of course, because of the news Sunday that a Dallas nurse who treated Thomas Duncan, the Ebola patient who traveled from Liberia and became the first to be diagnosed within the US, is herself ill with Ebola and has been isolated at the hospital where she works. Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention, confirmed her illness in a press conference and said that “at some point there was a breach in protocol and that breach in protocol resulted in this infection.”
When he said “protocol,” Frieden was indicating the elaborate but not complicated infection-prevention steps that healthcare workers take to protect themselves against infectious organisms that can spread from patients to their surroundings. The assumption is that at some point, the nurse may have slipped up in some minor way — rubbed her nose when she took her mask off, for instance — and transmitted the virus from the outside of her protective clothing to her mucous membranes or skin.
Here’s the thing: Infection prevention is a science of tiny details, all of them granular, almost none of them interesting to anyone outside the field. Granular means not just figuring out which protective equipment workers should wear in which situation — not as obvious as you would think, because the more you load them with gear, the more tired and distracted they become — but also determining the best ways to keep up their expertise in putting the equipment on and taking it off. It means designing room sinks so that bacteria don’t splash back out of the drain, and figuring out where to put shelves so nurses aren’t distracted on the way to the sink to wash their hands, and whether to focus on handwashing at all, or just encourage glove-wearing all the time.
Admit it: Unless you are yourself a medical professional, your eyes probably just glazed over. Yet knowing details like those makes a huge difference to controlling the spread not just of Ebola, but also multi-drug resistant bacteria, pandemic flu, TB, measles, whooping cough, and on and on.
But because of that eye-glazing response, infection prevention may be the most starved for research funding of all the medical specialties. If there were more infection-prevention research, the nurse in Dallas (and probably the one in Spain, who may have contaminated herself doffing her gear) might not have become infected. Hospitals would not now be wondering whether any of their procedures can protect them against this unseen threat. And medical thought leaders would not now be calling for a national reorganization of Ebola care that would medevac patients to a central location precisely because most hospitals are ill-equipped.
For documentation of the lack of infection-prevention funding, you cannot do better than the writing of Dr. Eli Perencevich, who has been highlighting the problem for years now with his colleagues at the wonkishly named Controversies in Hospital Infection Prevention and recaps the gaps in his latest post. Similarly, Dr. Judy Stone has been trying to bring attention to the lack of training. Also: Yesterday, Vox examined cuts to preparedness funding; this morning, Mike the Mad Biologist analyzed the misplaced priorities of the funding that remained; and Dr. Francis Collins, director of the National Institutes of Health, points out that, if not for funding cuts, we would have had the ultimate prevention tool — an Ebola vaccine — a decade ago.
The most telling point to me is that, when the news broke Sunday of the Dallas nurse’s infection, no one in my circle who works in infection prevention was even slightly surprised. Here’s a Storify of reactions worth reading.
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