Being In The Know About Ebola
Dr. Erlaine Bello
Hospital epidemiologist and medical director of infection prevention and control at The Queen’s Medical Center
Where did you receive your schooling and training?
I was born and raised in Hawaii and attended Radford High. Then I did my premedical education at Occidental College, where I earned a B.A. in biochemistry and religious studies. For medical school, I went to John A. Burns School of Medicine (JABSOM) at University of Hawaii. Then I completed the University of Hawaii Flexible Residency Program and University of Hawaii Integrated Residency Program in Internal Medicine. I also have a fellowship in infectious diseases from Harbor-UCLA Medical Center and a master’s in clinical research from JABSOM. Currently, in addition to my work at Queen’s, I am associate professor in the Department of Medicine at JABSOM, where I work with the residency program.
What first got you interested in the field of infectious diseases?
There is a lot of detective work and problem-solving in infectious diseases and infection control. There is constant challenge ― newly discovered microorganisms and diseases, more resistant bugs. In infectious diseases, you also deal with the intersection of the infecting agent with host and environment, both natural and the human-societal constructs in the environment. And I like that there is still potential for absolute cure of many infectious diseases as opposed to just suppressing or taming chronic diseases.
Has Ebola run its course, or does the world need to continue being concerned about Ebola? Might some other pandemic be more worrisome?
Of course the world must be concerned about Ebola. It is a rapidly lethal disease for which there is currently no cure or vaccine, and it has killed many thousands of people. It is an epidemic. It is not a pandemic. A pandemic is worldwide and has potential to affect more people but could have a lower death rate. It can be difficult to compare the impact of two very different diseases ― one that is distant from our day-to-day reality, with one that is in our house.
For example, seasonal influenza rates have started to rise significantly in our community in the past month and have not peaked yet. We definitely will see more patients admitted to the hospital with influenza than Ebola. Some of the patients with influenza who have serious underlying disease may die from influenza complications, but the average fatality rate for the whole population from seasonal flu is not as high as Ebola.
The isolation precautions required for Ebola patients to prevent transmission and keep health care workers safe is many magnitudes more complex than required for influenza. The resources required to care for a patient with Ebola are significantly greater than for caring for patients with influenza. There are also drugs that might shorten the course and lessen the severity of influenza, whereas we have no treatment with proven effectiveness for Ebola.
Is it possible that Ebola is creating new strains that can continue to spread and cause health problems around the world?
This is a difficult question to answer because all viruses have the potential to mutate. These mutations can affect transmissibility and how viruses spread from person to person. But for Ebola so far, there is no evidence that it is transmitted any differently than the original strain, which caused the first outbreak ever reported in Zaire in 1976.
What is it that made Ebola carry such a high risk of death?
In advanced disease, patients with Ebola develop multi-organ failure.
In the United States and other countries with advanced medical technology and sufficient resources, we can provide intensive supportive care early during this period of multi-organ failure and allow the patient’s immune system time to eventually deal with the virus. In Africa, without this high level of supportive care, many patients die of complications that are readily treatable in the U.S.
How much do Hawaii residents have to be concerned about Ebola?
While screening of travelers from Africa at high-risk entry points has been implemented, no system is perfect. The likelihood of having a patient with Ebola in Hawaii is low but not zero. Texas Health Presbyterian Hospital in Dallas likely did not perceive itself as a high risk, but its experience was a sobering wake-up call to all acute-care hospitals and all health care providers to prepare for “low but not zero” risks.
Is Hawaii prepared for an outbreak?
I cannot speak for Hawaii, but I do believe The Queen’s Medical Center has done everything within reason and within the limits of our resources to prepare as much as it possibly can. We realized early on that while this time it is Ebola, we really are practicing to deal with any serious contagious disease.
Because of our island status and our lack of access to clinical biocontainment units, it is in the best interest of all health care institutions to work collaboratively with the Department of Health and Healthcare Association of Hawaii to share resources and expertise for any outbreak, whether it is Ebola or measles or flu.
How can folks stay safe?
The best protection from Ebola is to avoid travel to countries in West Africa.
Anything else you’d like to mention?
It is important to put Ebola into perspective of all of the other issues in health care. While we in Hawaii need to be prepared to recognize patients at risk and to take care of a patient with Ebola, the likelihood of this happening is very low. We have used this as a learning opportunity to assess our hospital’s capacity to deal with any serious contagious disease. We have examined the chain of command and flow of information, reinforced basic infection control practices while educating on the much more complex personal protective equipment required for Ebola, and tested the resilience of the culture in dealing with a brand-new, scary infectious disease. We need to balance how we spend our time and resources training for a potential future Ebola patient when we have many more immediate patient-care needs in our community in the here and now. As always, education, education, education, measured action and common sense are essential components of dealing with any serious infectious disease to both care for the patient and prevent transmission.