There’s remarkable news out of Spain today about the nurse who was part of the team treating a Spanish priest who later died of Ebola and has now come down with Ebola herself. Teresa Romero Ramos’s case is the first apparent case of Ebola transmission in Europe. The World Health Organization is saying, not surprisingly, that we should expect more cases in Europe. But there’s a lot of news suggesting Spanish authorities, or at least the doctors at her facility, were fairly casual about monitoring the members of their team for signs of contagion.
Despite receiving some training in Ebola safety protocols, Romero apparently touched her face with her protective glove after leaving the quarantine room where the priest was being treated. This is the best guess as to how she was infected.
It seems like there were shortcomings in Romero’s training. And I would imagine that there is some inevitable level of mistakes on the part of medical personnel when dealing with such highly contagious fluids. (Romero had gone into the priest’s quarantine room to change his diaper when this incident appears to have occurred.) After all, numerous health care workers have accidentally stuck themselves with needles over the last three decades, though thankfully the great majority do not end up getting HIV.
It’s always important in cases like this that we, in most case outsiders, not jump to the conclusion that everyone’s a moron just because some mistake occurs. But what happened after Romero developed a fever – and until she was clearly deathly ill – seems iffy enough that it’s hard not to suspect a major failure of judgement and procedures.
This from the Daily Beast …
When Teresa Romero Ramos, the Spanish nurse now afflicted with the deadly Ebola virus, first felt feverish on September 30, she reportedly called her family doctor and told him she had been working with Ebola patients. Her fever was low-grade, just 38 degrees Celsius, far enough below the 38.6 degree Ebola red alert temperature to not cause alarm. Her doctor told her to take two aspirin, keep an eye on her fever and keep in touch, according to Spanish press reports quoting Romero’s husband Limón Romero. He says she didn’t initially exhibit any of the other Ebola symptoms: vomiting, diarrhea, nausea, and she didn’t feel sick enough to stay in bed.
Romero apparently took great comfort from the fact that her temperature had not reached the threshold for concern about Ebola. 38 celsius is 100.4 Fahrenheit. She had time off from work, ran errands, caught up with friends and even sat for a government civil service exam.
Just in ordinary terms 100.4 is a borderline fever. And I’m not sure how definitive that 38.6 (101.48 F) threshold is considered. But it would at least seem like you’d have a more aggressive regimen for people who worked directly with an Ebola patient. But it apparently got worse from there.
Again from the Daily Beast …
According to Spanish press reports quoting the Spanish nurses’ union, Romero called Carlos III hospital several times between September 30 and October 2 when her fever finally hit the 38.6 threshold. Still, it took until October 6 when she had become so deathly ill she was begging for an Ebola test before anyone at the hospital where she worked reportedly reacted. Then, rather than immediately isolating her and rushing her to the special ward used to treat the previous Ebola patients, they told her to go to the nearby emergency room at Alcorcón, where press reports say she sat in the public waiting room for several hours absent of any protective gear. “I think I have ebola,” she reportedly told anyone who would listen. But no one took notice until her first test came back positive. By then, dripping with fevered sweat, she would have been inarguably contagious.
Not surprisingly, Spanish public health officials are now being scrutinized pretty aggressively – not only by the public but also by EU authorities. To further complicate matters, there’s further controversy and a social media campaign opposing Spanish authorities decision to euthanize Romero’s dog.
