Ebola Wars

What’s it like right now to be on the front lines of treating Ebola victims in West Africa, or in the past few weeks, even here in the US? Given that this battle might be waged in my community tomorrow, it would be nice to know that we healthcare providers are getting smarter in humanity’s tectonic battle. The traditional peer-reviewed journals do a credible job of publishing the major studies for a disease like Ebola, even on an accelerated basis; in fact when it comes to hot subjects like Ebola, such journals cannot publish fast enough. It may well be, however, that this disease is not defeated by a big scientific breakthroughs or insights, but rather myriad little things. In fact that is the kind of stuff I want to learn about; which detailed little steps in terms of containment, infection control, tracing of contacts etc. seem to be working against this disease and which are not?

Clearly something wasn’t working correctly when two nurses caring for the first Ebola patient in the U.S. contracted the disease! Over the past week I have certainly received my daily dose of The New York Times and NBC TV reporting about what went wrong, however, I would like to read about the subject after it has been vetted by medical professionals via the peer review process. What, if anything, did the infectious disease unit, ICU or any other staff at Dallas Presbyterian learn in the past 2 weeks? It seems impossible to believe that absolutely nothing has been learned. Even if expert analysis of the problem is incomplete, they probably have some working hypotheses. Is training an issue? Are the wrong gowns being used? What about facial splash shields? There are dozens and dozens of small things being practiced by the medical teams caring for Ebola patients, some of which worked and some which might not have, yet for most of us, the best source of info is, frustratingly enough, the news media.

Clearly my “ask” will find its share of critics. It is rightfully argued that incomplete knowledge is misleading and potentially dangerous if misinterpreted. If the physicians on the front lines of the Ebola fight arrive at incorrect conclusions as a result of a rushed analysis and this information is passed on to the medical community via journals, patients could die. But such a paternalistic critique assumes that the physicians and nurses reading the early lessons of this war are incapable of understanding that such observations are preliminary. How can it not be better to learn from experienced healthcare providers via medical journals than it is to rely on mass media or alternatively, know nothing?

The current approach to disseminating knowledge about the Ebola fight seems to be through panels of “experts” like the CDC or Doctors without Borders or other Federal and State government organizations. This method of establishing protocols is, in an emergency, clearly necessary and needs to be done. Anyone who has ever participated on such committees, however, will tell you that political considerations invariably color recommendations, especially when quality information is scant. For this reason I believe that rapid communication via the peer-reviewed publication process can supplement expert guidelines and keep the “expert” community from straying into all too common political minefields. Moreover, even experts can wrongly interpret some procedure as being inconsequential when in fact it is the key to success. When it comes to publishing seemingly trivial information about a scary and fast moving disease like Ebola, I say simply, “bring it on.”

What if the secret to controlling Ebola is a specific technique for cleaning bedpans? And what if some low ranking nurse has stumbled upon the answer about how to do it right? What if, unsurprisingly, the big government experts are oblivious to this nurse’s unique insight? It might well take 100 years before such unglamorous information was to make it into Lancet or NEJM; there are just so many barriers to vetting and communicating this type of idea in the conventional medical journal world. It is into this void that Cureus would like to boldly step. In the Cureus world of publishing no medical idea submitted in scientific good faith is too humble to be vetted and rapidly and widely communicated through the peer review process. So I say, if clean bedpans could be the answer to eradicating Ebola, let’s hear your story. And once it is published, I trust the wider court of medical expertise will be there to either vet or discredit your idea through Cureus’ SIQ process. A great idea, no matter how humble the origins, is a terrible thing to waste during an epidemic like Ebola.

Although I am far away from the front lines of Ebola, I have been in the trenches of publishing in peer-reviewed medical journals for almost 30 years and I am doubtful that all important information is being documented at the rate at which it’s learned. Nevertheless, since I am not an infectious disease expert nor on the front lines of the current epidemic, I’d love to hear what experienced (with Ebola) physicians think about the hypothesis I have put forward here.

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