Monday, November 17, 2014

12th and Marshall: What Not to Wear

The Virginia Commonwealth University School of Medicine has a new Alumni magazine titled 12th and Marshall.

I was recently featured in an article titled What Not to Wear.

The genesis of the VCU bare below the elbows infection prevention recommendation is from Mike Edmond, as neatly summarize in My New White Coat is a Cool Black Vest.

Change is afoot.

Tuesday, November 11, 2014

Fear, Ethics and Ebola

It seems that Ebola preparedness continues to occupy much of my time. My blogging has been very ''light'' as of the last month or so.

I came across some interesting articles this past weekend. Here is a thought provoking article in the New York Times on the ethics of infection. In particular, the author explores the ethical obligation of a potentially infected person, such as a healthcare worker who has cared for an Ebola patient,  to personally limit contact with others. This is an important concept as the notion of the collective good is frequently counter cultural in the USA, where individual rights prevail.  

The NY Times Magazine article on fear and Ebola by Abraham Verghese is a worthy read. Dr. Verghese likens much of the current Ebola fear to that of the panic in the early 1980's with the appearance of AIDS. Public fear can lead to concerning negative consequences such as punishing healthcare workers rather than rewarding them after they put themselves at risk by caring for patients with Ebola. We do not need fewer volunteers in this crisis.

Misguided and misinformed notions can significantly stifle the dangerous and laudable work that is required to limit the current Ebola epidemic.

Monday, October 27, 2014

Visiting Professorship, Airport Screening for Ebola

Medical Library- University at Buffalo
I spent last week at the University at Buffalo School of Medicine and Biomedical Sciences as a visiting professor (Infectious Diseases). Given that UB Med is my medical Alma Mater, this was a huge honor for me.

Butler Auditorium- University at Buffalo

I am back at VCU, seeing patients and collaborating with many others on our ongoing Ebola preparedness. Although not immediately relevant to our Hospital Infection Prevention Program, I am frequently asked my opinion on airport screening and travel bans. 

This editorial published in  the British Medical Journal summarizes much of the key arguments on Ebola screening at airports. Even as we embark on airport screening, we should not fool ourselves that it will be an effective mechanism to limit the entry of Ebola into the USA. A review of the evidence, particularly for mass screening at airports during the SARS epidemic, suggests that screening, including thermal scans, will detect few cases. Many will not self report symptoms. Also, the longer the incubation period of the infection (up to 21 days for Ebola), the greater the chance of being asymptomatic at the time of screening.

Airport screening may give us a false sense of security. Efforts and resources should be directed at mass public health messages on where to seek prompt medical care  for those at risk of Ebola virus disease. 

More importantly, resources are needed on the front, in west Africa.

Thursday, October 16, 2014

Ebola and RVA

The last 72 hours have been exceedingly hectic as we worked through a suspected Ebola case. In the end, the much feared infection was excluded. As with many crises, many lessons are learned and many issues are still evolving.

The Richmond Times Dispatch published this editorial on our response to the Ebola threat. Today, our very own Dr. Richard Wenzel published this thoughtful commentary in the Richmond Times Dispatch. 

Other recent media include these print interviews where I am quoted, accessed here and here. A recent Channel 12 interview can be viewed here while a Channel 8 appearance is accessed here.

Monday, October 13, 2014

ID Week 2014

With Nadia Masroor at ID Week 2014
Last week was exceedingly busy at the ID Week 2014 conference. In addition to various SHEA related committee meetings, we presented our data on de-escalation of contact precautions for endemic MRSA and VRE (Presented by Dr. Michael Edmond).

Nadia Masroor presented our scientific abstract on perceptions and barriers to universal gloving.

Now I am back to work, back to the grind and back to Ebola emergency preparedness. 

Friday, October 3, 2014

Enterovirus and Ebola Media Attention

The last several days have been a bit of a media frenzy with Enterovirus and Ebola, both locally and nationally.

Here is a link to a WRIC Channel 8 television interview I did on both Enterovirus and Ebola.

Here is a link on another interview, with a focus on Ebola, for CBS Channel 6.

I also participated in a live Twitter chat, accessed here.

Monday, September 29, 2014

Death in the White House: William Henry Harrison

I am back on the infectious diseases consult service this week so my attention will be diverted to clinical care. Regarding infectious diseases cases, here is an interesting article published in Clinical Infection Diseases titled Death in the White House: President William Henry Harrison's Atypical Pneumonia.

The article challenges the long maintained notion that pneumonia killed William Henry Harrison (1773-1841) just 1 month after he became the ninth president of the United States. A careful review of the detailed case summary written by his personal physician suggests that enteric fever, not pneumonia, was the disorder that killed the president.  

Although President Harrison did have some pulmonary symptoms, the case summary highlights the progressive abdominal symptoms that ultimately led to sepsis and death. Emphasis is placed on the unsanitary condition of early 19th century Washington, DC. The water supply of the White House was 7 blocks down from a repository of ''night soil", a euphemism for human feces. Given that a sewage system was non-existent, runoff most likely contaminated the water supply, increasing the likelihood of enteric fever. 

I previously blogged about the death of President Garfield, as chronicled in the Destiny of the Republic, another worthwhile read.

Then, as in now, physicians subscribed to the tenet of primum non nocere. Ironically, unbeknownst to them, the treatments, both in the cases of Presidents Garfield and Harrison, were toxic and led to greater harm than good. 

Good intentions, bad results.