Sunday, March 1, 2015

New York's Ebola Doctor Speaks Out

The Blessed Bernardo Toloni Visiting Victims of the Plague -- Giuseppe Crespi

Craig Spencer, the New York doctor who contracted Ebola last year, has written a passionate and savage critique of the city's response to his diagnosis.  It was published last week in the New England Journal of Medicine.

You will remember his case.  He was the physician who returned last fall from West Africa, where he had treated Ebola patients in Guinea, and resumed his normal life.

He detailed the fears he had felt and the precautions he had taken:

      "While in . . . Guinea, I kept a journal to record my perceived level of risk of being infected
        with the deadly virus. A friend . . . had told me that such a journal comforted him. . . . On
        a spreadsheet delineating three levels of risk — minimal, moderate, and high — I'd been
        able to check off minimal risk every day after caring for patients."

       "While in Guinea, I often woke up sweating in the middle of the night, my heart racing. I
        might have felt warm, but my thermometer would read 97.7°F — perhaps it was broken?
        I started diagnosing myself with gastritis, amebiasis, peptic ulcer disease. Though I
        understood the connection between psychological stress and physical pain, I'd never
        experienced it like this." (Dr. Spencer had worked "in places just miles from active
        conflict," but, he wrote, "this microscopic virus, an invisible enemy, made me uneasy.")

        Once back in New York, "I became fearful of the incredibly remote possibility that I could                   become sick and infect my fiancée, the person I love the most. Touching others and shaking                 hands — forbidden actions throughout West Africa — still made me uncomfortable. Twice
        a day, I held my breath in fear when I put a thermometer in my mouth. "

One morning, days after his return to the U.S., Dr. Spencer woke feeling ill.  He was taken immediately to Bellevue Hospital, where after three weeks he was cured and released.

     "Though I didn't know it then — I had no television and was too weak to read the news —
      during the first few days of my hospitalization, I was being vilified in the media even as my
      liver was failing and my fiancée was quarantined in our apartment. One day, I ate only a cup
      of fruit — and held it down for less than an hour. I lost 20 lb., was febrile for 2 weeks, and                   struggled to the bathroom up to a dozen times a day. But these details of my illness are not                   unique. For months, we've heard how infected West Africans, running high fevers and too
      weak to move, were dying at the doorsteps of treatment centers. We've seen pictures of dying             children crippled by vomiting and diarrhea and unable to drink."

When he later learned the reactions of press and politicians, Dr. Spencer was infuriated.

      "My activities before I was hospitalized were widely reported and highly criticized. People
      feared riding the subway or going bowling because of me. The whole country soon knew
      where I like to walk, eat, and unwind. People excoriated me for going out in the city when
      I was symptomatic, but I hadn't been symptomatic — just sad. I was labeled a fraud, a
      hipster, and a hero. The truth is I am none of those things. I'm just someone who answered a
      call for help and was lucky enough to survive.

      "People fear the unknown, and fear in measured doses can be therapeutic and inform
      rational responses, but in excess, it fosters poor decision making that can be harmful.
      After my diagnosis, the media and politicians could have educated the public about Ebola.                   Instead, they spent hours retracing my steps through New York and debating whether Ebola
      can be transmitted through a bowling ball.

      "Little attention was devoted to the fact that the science of disease transmission and the                        experience in previous Ebola outbreaks suggested that it was nearly impossible for me to
       have transmitted the virus before I had a fever. "

The doctor speaks of the satisfaction he got from treating desperately ill people in Western Africa and the importance of encouraging doctors and nurses to travel to and help in such situations.  When they return, he says we should not quarantine them but trust them to follow science-based protocols to protect themselves and others.

His conclusion:

      "When we look back on this epidemic, I hope we'll recognize that fear caused our initial
      hesitance to respond — and caused us to respond poorly when we finally did. I know how
      real the fear of Ebola is, but we need to overcome it. We all lose when we allow irrational fear,
      fueled in part by prime-time ratings and political expediency, to supersede pragmatic public                 health preparedness."

Note:  Dr. Spencer did not infect anyone in the U.S. with Ebola.  Our country has not had a single reported case of the disease since his release from the hospital on November 10.

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