There is always a residual risk. Isolated cases of Ebola can therefore also occur in Germany – but not an epidemic, says tropical physician August Stich.
Taking temperature on entry at Skopje airport: if you don’t have a fever, you can’t infect anyone with Ebola. Picture: ap
site: Mr. Stich, in the USA – with one of the best health care systems in the world – a nurse has contracted Ebola in the clinic. In Spain, a female nurse has fallen ill., Ebola patients from West Africa are also being treated in Germany, one has just died in Leipzig. The Federal Minister of Health still considers an Ebola infection in this country unlikely. A naive hope to reassure the population?
August Stich: There is never 100 percent certainty, but with good equipment and proper training of personnel, the residual risk is extremely low. And even if there were individual secondary infections, we will not have an outbreak with the dynamics we are currently experiencing in West Africa.
What makes you so safe?
We have seven highly specialized treatment centers in Germany with very well-trained doctors and nurses and laboratory staff. They have maximum protective equipment and regularly train the procedures in the special isolation wards.
Didn’t that also apply to the nurses in the U.S. and Spain?
No. The Spanish hospital did not have sufficient such personnel. We still know too little about the infection route in the USA. But, clearly, we need to identify weaknesses and learn from them.
How is it possible to become infected despite wearing protective clothing?
Our position is that someone who uses the protective clothing properly and is trained is safe. However, this does not rule out human error or an accident, such as a needlestick injury.
Born in 1960, he has been head of the tropical medicine department at the Mission Medical Clinic in Wurzburg since 2004. Previously, he worked as a physician in Zimbabwe, Somalia, Cambodia, Angola and Tanzania and was on the board of the German section of Doctors Without Borders. His focus is on clinical tropical medicine and the care of patients with a migration background. His scientific work focuses on sleeping sickness, malaria and HIV.
What does that mean?
If a nurse draws blood from a patient and then sticks a needle through his protective glove, he can become infected. Or if he accidentally touches a splash of blood while taking off his protective clothing and then wipes his eyes with his hand. The crucial thing, however, is that such individual cases do not trigger a chain of infection.
But this is precisely the fear that many people have.
A second case of the disease is not synonymous with an epidemic. This will not happen in Germany.
But if it does – how many people can be treated?
Our seven centers are structurally designed for about 50 beds. But these beds cannot all be occupied at the same time. We have to allow for sufficient staff and time for disinfection. It also depends on how intensive the treatment of each patient is. So the true number of those who can be treated is much lower.
Let’s assume that a traveler from West Africa does not contract Ebola until he arrives in Germany. Who is supposed to know how many people he had contact with before? Who is supposed to locate them, who is supposed to monitor them? That quickly exhausts the 50-bed capacity, doesn’t it?
This is exactly where the thinking error lies, which quickly leads to panic: A patient who does not yet have a fever does not pose a threat. Someone who develops Ebola symptoms tomorrow cannot infect anyone today.
But as soon as he develops symptoms?
Then he must be isolated immediately, of course. But that doesn’t mean that all contact persons have to be isolated as a precaution.
They just have to be monitored, they have to take their temperature several times a day. The health authorities take over this care.
They are no longer allowed to leave their homes, they are not allowed to go to school or work?
You have to look at each individual case to see which conditions make sense. First of all, there is nothing to stop symptom-free people from going on with their normal lives. However, there are people for whom the knowledge that they have had contact with an Ebola sufferer has a strong psychological impact. These people would merely drive their surroundings crazy and should stay at home.
The public health service in Germany is organized on a decentralized basis. Do the requirements vary from city to city?
The public health officer in charge has the power of decision. The rules by which he must act are laid down centrally by the Robert Koch Institute.
Anyone who has a fever, is vomiting or has a severe headache probably first goes to the family doctor – and may not even be recognized there as a potential Ebola patient.
Doctors with first contact with patients are in greater demand than ever. They have a duty to inform themselves, to be vigilant, to ask exactly where the patient has been for the last three weeks. They set the decisive course. Doctors in Germany can obtain the necessary information. No one can pretend that they have never heard of Ebola.
Starting on Thursday, the EU health ministers will discuss how to prevent the spread of Ebola in Europe. One of the options under discussion is to order compulsory collective fever tests for all people arriving from West Africa.
These checks are already being carried out when people leave the Ebola regions. However, all other measures must remain practicable.
You yourself have worked in Africa for a long time. Now you are training doctors and nurses before their deployment in the fight against Ebola. The working conditions on site do not meet our clinic standards. Do you have a guilty conscience toward your colleagues?
A certain residual risk is part of our profession. We try to keep it to a minimum. We are now being accused of bringing the dangerous disease to Europe by helping. The opposite is true: we must do everything we can to effectively combat Ebola in West Africa. Containing the epidemic in Africa is the best prevention for the spread of the virus.