When Healthcare providers get sick

    It is an interesting drill when a health care provider gets sick.  For most of us, most of the time, we can recognize what is going on and make a decision whether to treat ourselves (if minor) or get with a colleague.  It is a little different here.  Certainly, there are a lot of illnesses as one would expect in a developing world country.  But the specter of Ebola distorts the normal way you approach a set of symptoms.

     First you have to start with the WHO case definitions of Ebola.  A probable case of Ebola consists of a known contact with the virus, and usually a fever sometimes with a constellation of symptoms that can include diarrhea, vomiting, fatigue, sore throat, unexplained bleeding, headache, abdominal pain and hiccups.  A suspect case of Ebola will have the fever with the symptoms without a known contact.  A confirmed case requires a confirmatory blood test.

     The problem is that many of the common illnesses that occur here can have those same symptoms with a fever.  Food borne illnesses, malaria and many others can cause some or all of the symptoms, with bacterial gastroenteritis being a particularly common offender.  Particularly for people whose GI tracts are not used to the local bacteria.

     As a health care provider in an Ebola zone, you can easily recognize these symptoms when they occur in you.  The risk is that you could minimize their significance.  Clinically you know that when these symptoms are due to Ebola, they are usually severe, but you also know that all severe symptoms start out as not so severe.  So, you fall back on the algorithm that says;  fever plus 3 typical symptoms without known contact equals Ebola suspect.

     There is the formal algorithm that states that the patient will be admitted to the suspect ward of the ETU until there are two negative blood tests separated by 48-72 hours.  There is also an informal algorithm for healthcare providers that, if the symptoms are not severe, you can have your blood drawn and go into self isolation pending worsening or improvement of symptoms.  Dependent upon how you do, you may need a second test.  Sometimes it is good to be the doctor.  But it is even better to have a negative Ebola test.  To my friends and family:  I have not been ill.