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How Ebola Is Being Transmitted Airborne

How Ebola Is Being Transmitted Airborne

By Dennis Loo (10/15/14)

Two health workers at Texas Health Presbyterian Hospital where Liberian Thomas Eric Duncan was treated and died from Ebola have now tested positive for Ebola. Hospital spokespeople expressed astonishment that first nurse Nina Pham and now a so-far unidentified health care worker contracted Ebola, despite wearing facemasks, gowns, gloves, et al, as per their supervisors’ instructions and CDC protocols.

When Pham came down with Ebola, officials initially blamed her for not following proper procedures. A strikingly similar sequence of events has occurred in Spain, with two nurses coming down with Ebola who were following the instructions they were given, with government spokesmen initially blaming the nurses - and then in response to angry protest, retracting their pompous blaming - for the nurses' contracting the disease.

As this article (“Health workers need optimal respiratory protection for Ebola”) by national respiratory protection and infectious disease experts Lisa Brosseau, SCD, and Rachael Jones, PhD, published in the Center for Infectious Disease Research and Policy on September 17, 2014, makes clear, however, Ebola can be transmitted through facemasks by being aerosolized through coughing, sneezing, or even, we should assume, breathing by an infected person.

The current official doctrine is that Ebola can only be transmitted by direct contact, but this is clearly not true. As Brosseau and Jones state in their article:

We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.1

The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.

We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.

There has been a lot of on-line and published controversy about whether Ebola virus can be transmitted via aerosols. Most scientific and medical personnel, along with public health organizations, have been unequivocal in their statements that Ebola can be transmitted only by direct contact with virus-laden fluids2,3 and that the only modes of transmission we should be concerned with are those termed "droplet" and "contact."

These statements are based on two lines of reasoning. The first is that no one located at a distance from an infected individual has contracted the disease, or the converse, every person infected has had (or must have had) "direct" contact with the body fluids of an infected person.

This reflects an incorrect and outmoded understanding of infectious aerosols, which has been institutionalized in policies, language, culture, and approaches to infection control. We will address this below. Briefly, however, the important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract.

The second line of reasoning is that respirators or other control measures for infectious aerosols cannot be recommended in developing countries because the resources, time, and/or understanding for such measures are lacking.4

Although there are some important barriers to the use of respirators, especially PAPRs, in developing countries, healthcare workers everywhere deserve and should be afforded the same best-practice types of protection, regardless of costs and resources. Every healthcare worker is a precious commodity whose well-being ensures everyone is protected.

If we are willing to offer infected US healthcare workers expensive treatments and experimental drugs free of charge when most of the world has no access to them, we wonder why we are unwilling to find the resources to provide appropriate levels of comparatively less expensive respiratory protection to every healthcare worker around the world.

Note the date on the publication of Brosseau and Jones’ article, September 17, 2014, before these outbreaks in the First World. In Ebola we can see how those who are in charge of the health and fate of all of us, both in the Third World and the First, are too pre-occupied with the virulence of ISIS, too arrogant to realize the error of their policies, and too slow institutionally to respond appropriately. When I first heard about Nina Pham being told that a facemask was enough I thought to myself: “How can you think that a permeable facemask is going to prevent her from getting particles airborne from a patient?” The Brosseau and Jones’ article definitively makes clear why health care workers must be provided with independent respiratory outfits.

Elaine Brower 2

Elaine Brower of World Can't Wait speaking at the NYC Stop the War on Iran rally 2/4/12