Containment

The average person with Ebola won’t infect more than two more people (but that alone is a scary multiplier effect), and the virus is not airborne. But man does it love bodily fluids, dry cracked skin, eyes, mouth, etc. and a single drop of blood can contain millions of viral particles, any one of which can spread the disease. It isn’t remotely as contagious as the flu, mumps or even dreaded HIV. But when it does infect, the results are usually deadly.

Until infected blood completely dries, which can take days or even weeks, that blood carries and sustains a live virus. Still it kills, spreads where it shouldn’t, and the CDC do not seem to have fully understood how such tiny viruses can pass through what are, normally, impermeable membranes in clothing with obvious gaps within the design specifications of most hazmat suits. And while hazmat suits have developed from the WWI model shown above, there is a real question as to whether they are really up to current demands.

“The organization [CDC] recommends double gloves (quality unspecified), ‘waterproof’ boots or booties, an n95 mask--which is a pretty standard surgical mask that can block 95% of airborne particles--and that you not expose your skin… Neither the CDC nor WHO takes a stance on the grade of suit material that should be used to protect against Ebola.

“In Africa now, Doctors Without Borders volunteers have been wearing suits produced by Dupont made of either Tyvek or Tychem material. Each is a woven textile, coated in patented industrial goo. (Similar suits are sold by a small handful of competitors.) These suits aren’t seamless footy-pajama-style garments. For the full-skin protection recommended by the CDC, they necessitate boots, gloves, surgical masks, and facial splash guards be added as well. And to seal the seams between a pant and boot or a glove and shirt, doctors will often use duct tape.” FastCompany.com, October 27th.

Africa? Think about those effectively deployed suits, every nook and cranny taped, sealed without porous risks… in a hot African building/village without air conditioning… wearing the suit for hours and hours on end. Feeling dizzy yet? Sweat dripping down your eyes. Burning. Beyond uncomfortable. Virtually intolerable and unwearable.

“[Dr. John Hardham, PhD, former Medical Director at the Office of the Assistant Secretary of Defense for Nuclear and Chemical and Biological Defense Programs] says. ‘When you’re wearing a suit of Tyvek-type material, that lets nothing in and nothing out--which also means your heat and your sweat get trapped in. You will generally end up with a puddle in your shoes because you’re sweating so much.’” FastCompany.com. If you can last an hour under such conditions, you are doing well.

It’s easier here, under more controlled environmental conditions, but exactly how are fabrics are tested and qualified? “Both the U.S. and the European Union have their own somewhat convoluted grading systems for assessing the permeability of personal protective materials like Tyvek, in which independent labs put the materials through a series of tests and rate their performance. The E.U.’s tests, in particular, sound like strange, gruesome delights: soaking material in fake, red blood that’s been filled with bacteria and spraying an aerosol of viruses at a cloth then checking how many virus particles made it through.

“Dupont makes no promise that Tyvek shields wearers from viruses. It’s unranked, falling below the lowest grade, which E.U. standards would call Class 1. (A Class 1 material, sprayed with aerosol mist, allows 10% or more of the contagion through in lab testing.) Its liquid resistance doesn’t fare much better. In just 15 minutes, blood can soak through the material, bringing dangerous pathogens along with it.

“Tychem, and its peers, are Class 3 against viral aerosols--stopping all but .001% of viruses trying to make it through. They’re about as cheap as Tyvek. And they can be soaked in blood for more than 75 minutes before contaminants begin to pass.” FastCompany.com. To make matters worse, the standards for such containment suits are constantly changing, because we are learning all the time.

But taking care of infected patients or disposing of the deceased victims means coming into contact with them. No way around that. Aside from the heat, there are other issues with protective gear: “The plastic lenses of shields and goggles you wear over your eyes can warp your vision. Sweat can blur your vision further. And bulky headgear, like ventilators or gas masks that you would use for optimal protection, limit your field of view so much that you have to purposefully look down when you walk, and up to make sure you don’t hit your head through door frames.

“Tactility, too, is a problem. You simply can’t feel if your protective, Tychem booties have ripped from the weight of your body pushing them into sharp a sharp rock. Thicker gloves mean that you can’t feel what you’re touching, and a pointed instrument could poke through a suit at any time. ‘Could some of the needle sticks be associated with that? It’s possible,’ Hardham says. ‘There are [guidelines] on how you’re supposed to recap a needle, but sometimes there’s human error. Instead of one-handed, they go two-handed and stick themselves.’” FastCompany.com.

We are loath to take risks in severe medical conditions, but risk is what our medical practitioners cannot avoid in this deadly space. A nurse or doctor become infected, and panicked officials and their constituents want precise answers about what went wrong, exactly how the virus was transmitted. But the exact instant of infection is almost never ascertainable. Political reactions can range from what I call the North Korean response – stop anyone crossing the border (tourists, etc.) until Ebola is gone to the testing procedures were are seeing at major airports. Where were the politicians when they had a chance to vote on programs that would prevented or cut short this Ebola outbreak?

We could have built better protective suits, some with cooling systems, but since the government has pulled significantly out of the research business, what was the private sector incentive to build such perfect suits? “[T]he personal protection equipment industry has little incentive to create an Ebola-proof suit because it can’t bank on an Ebola outbreak. Equipment companies generally serve factories, and other places where workers need protection from chemicals.” FastCompany.com. Same issue with the kind of research that could have stopped this outbreak dead in its tracks.

We could have had treatment or prevention options, but we saved a ton of money by cutting research into that field, so we are going to be exposed to dozens of untested possibilities in the next few months, foisted on us by the World Health Organization. And we are now finding Constitutional challenges to legally-mandated quarantine procedures by those required to submit to them. There are no easy answers, but this disease will eventually be contained.

The bigger question is whether we actually learned anything from this horrific experience or whether we live in a future-vision-impaired world, where we are willing for disaster to strike, our children to be under-educated and our infrastructure to fail before we RE-act. I fear this is just an event… not a lesson.

I’m Peter Dekom, and we seem to live in a “we only learn stuff the hard way” nation.