Fighting Fear, Fatigue on the Front Lines of Ebola
By Brenda Goodman, MA
Reviewed by Arefa Cassoobhoy, MD, MPH
Aug. 7, 2014 -- As the CDC continues to investigate how two Americans caught Ebola at the hospital where they worked in Liberia, another expert on the front lines of the infection says the answer is probably far more mundane than most people realize: They were exhausted.
Joseph Fair, PhD, is a molecular virologist with the Department of Defense. He's serving as a special advisor to the minister of health in Sierra Leone, the country hardest hit by the outbreak.
Doctors and nurses caring for patients in Ebola wards are trained in the painstaking process of infection control, Fair says. They're also issued head-to-toe white, Tyvek suits known as personal protective equipment, or PPE.
"Tyvek doesn't breathe. You're in some of the hottest, most humid conditions you can imagine," Fair says. "In addition, you're wearing goggles, rubber boots, and surgical gloves. You can imagine, after a 10-hour shift, you haven't eaten. You get an itch on your nose, and without thinking you reach up and scratch your nose. And damn, you've had an exposure."
"It's those types of small little things that happen. It's not because people aren't trained or aren't being careful," he says.
'Just Like Battle'
To make matters worse, many of the local doctors and nurses at Kenema Government Hospital in Sierra Leone have stopped showing up to work.
"They're scared to death," Fair says. "This is just like battle, right? You either have people who run into the danger or people who run away from it," he said in a telephone interview from Africa on Wednesday.
Fair has worked at Kenema Hospital before, but his vantage is a bit higher for this outbreak. He's helping to coordinate the surge of resources the U.S. and other countries are sending to the region in an effort to contain the spread of the disease.
The doctors and nurses who remain at the hospitals are stretched almost to their breaking points, he says.
"They are given training before they ever go in, before they ever put the suits on. It's called 'just in time' training, because that's what it is. It's given to people who've never seen a hemorrhagic fever before," he says.
"They're wearing the protective gear, but most people have never worn it before."
And the working conditions are unpredictable.
"You can't control when someone is going to vomit on you. You can't control working a 90-hour week," he says.
It's this "perfect storm" of conditions, Fair says, that's made the outbreak so hazardous for health care workers.
In Sierra Leone, the disease has claimed 50 hospital workers, or roughly 11% of the confirmed cases in that country. In Liberia, 15% of those who've died from the virus were doctors or nurses who caught the infection on the job, the Wall Street Journal reports.
The CDC says we may never know how the two American aid workers became infected.
"For every facility caring for people in that area, there needs to be meticulous infection control to protect not just the health care workers, but also patients' families, other patients," CDC Director Tom Frieden, MD, MPH, said in a press briefing last week. "Hospitals become amplification points if there isn't meticulous infection control."
Fair agrees, but he points out that infection control practices are only as good as a person's ability to stick to them. And things can slip when people are tired.
He knows this all too well. In recent weeks, he's lost two close personal friends, a nurse and a doctor, to the unforgiving virus. They were infectious disease veterans, having cared for sick patients through an outbreak of Lassa fever, a close cousin of Ebola.
"They had experience," he says, but this time they were dealing with "10 to 20 times more patients than we've ever had before."
For a time, Fair, an expert in Ebola diagnostics, was even testing his own blood for the virus.
When he arrived in Kenema, he gave a hug and a kiss to Mbalu Sankoh, the chief nurse at the hospital. He describes her as a mother figure to him.
Two days later, she developed a fever. Eight days later she was dead.
"I'm trying to stay emotionally objective," he says. "But it's never happened before with close personal friends."
SOURCES: Joseph Fair, PhD, MPH, special advisor to the minister of health, Sierra Leone, Africa. CDC, Telebriefing on the Update on Ebola Outbreak in West Africa. The Wall Street Journal: "Ebola Virus Inflicts Deadly Toll on African Health Workers." WHO: "Ebola Virus Disease Update, August 6, 2014."