Ebola in My Newsfeed and in My Clinic

It seems everywhere I go and look I see reports about Ebola.  After reading through a number of essays online that were shared in my Facebook newsfeed, I couldn’t help but respond.

An Op Ed by Frank Bruni in the New York Times encouraged us not to panic about Ebola, but rather observe a number of safety measures that most pediatricians counsel about regularly, such as seat belts, flu shots, and gun control.  Many other news media, such as this New Yorker article, warned against the spread of fear that Ebola is causing as the coverage of this epidemic picks up.  Over and over again I read messages that told me don’t fear Ebola, fear these other more common and realistic threats.  And yet I couldn’t help but feel nagging thoughts of can’t I fear both and what’s wrong with a little fear about a deadly disease?

While I practice prudence, as Frank Bruni encourages, and immunize my children, insist on car seats and bike helmets, and maintain a gun-free home, I also spend a portion of my week worrying about things that are far outside my immediate control, and right now that includes Ebola.  As a physician, I can’t just dismiss a major public health threat.  After all, the CDC initially told me that there was nothing to worry about and that things were under control, then two nurses were diagnosed.  The news repeatedly states that there is a concern about Ebola spreading to health care workers, which is my profession.  There are plans to regionalize care of Ebola patients, which includes participation of my hospital.  So I will still continue to get my annual flu shot, wear my seat belt, and wash my hands, but I will also stay informed about what is happening with Ebola and maintain a healthy dose of fear.

And what is wrong with a little fear?  My practice has seen an increased number of phone calls related to concerns about Ebola.  People who have never traveled outside the country and have no contact with international travelers are coming in worried that they have Ebola.  People misunderstand how Ebola is spread and how it can and cannot be treated.  What I have found though is that after I educate them about Ebola, parents are still interested in protecting their children from other diseases, such as flu, HPV, and pneumococcus.  It seems that their fear regarding deadly Ebola infections reminded them that there are other potentially deadly infections out there that we CAN immunize against.  When bombarded with news coverage about a scary disease and feeling helpless, it makes parents regain some sense of control in acting to protect their families by immunizing them against real threats.  So while I don’t want the media to scare families or spread misinformation, I think the messages of being attentive, preventing the spread of infections, and being forthcoming with your medical providers are important.  In my clinic, Ebola has motivated many parents to make healthy decisions for their children, not only in giving immunizations but talking about hand-washing, staying home from school when sick, and not sharing beverages.

One of the best pieces of Ebola coverage that I have read is this one from Arthur Caplan, PhD, at NYU, looking at the situation from a bioethics perspective.  As he points out, if we fight Ebola with an “expert, regional response” and start to agree on what quarantine means, we don’t have to fear Ebola and can go back to worrying about things like the flu.  In my practice, I will continue to screen patients appropriately who may be at risk for this awful infection, debunk myths about Ebola, help parents focus on the things that they can do to protect their children from all illnesses, and maintain an intellectual curiosity about how our country responds to this global public health threat.

 

 

The above opinions are my own and do not represent my employer.

For Healthcare workers:  See here for tightened guidance for US healthcare workers on personal protective equipment for Ebola, released October 20, 2014.

One Year

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One year ago we welcomed a baby girl, who now is starting to walk and talk and teach us about the person she is.  It has been an amazing year and we have been enjoying celebrating all week with the little girl who made it so.

Observations of the birthday girl:

Teeth: 2

Words: Uh-oh, Dada, Up, Duck

Loves:  animals and her brother

Favorite foods:  mashed potatoes and milk

Favorite part of bedtime: brushing teeth

Party theme: milk and cookies

What she is getting for her 1st birthday: a flu shot

Happy Birthday, G!

 

The Germs We Wear

Fall_2014As pediatricians, we know that we will be exposed to a variety of germs throughout the day and this is never more obvious than during flu season when we see coughing patient after coughing patient.  With young children at home though, many of us wonder what the risk is of bringing home these germs on our clothing and belongings.  Informally I have polled my colleagues and found that we all have different after work rituals to decontaminate ourselves, varying from nothing to showering and changing clothes.  I’ll admit that my personal practice differs depending on the day and a variety of factors, including practicality and convenience.

It is hard to know what the actual risk is though, since different germs live for varying durations outside the human body and some live better on hard surfaces than fabrics.  It has long been known that doctors’ white coats can be transmitters of bacteria, especially in surgical sub-specialties and inpatient units.  Similarly, it has been shown that ties are frequently carriers of bacteria, as they dangle over patients and drape across a variety of surfaces.  One 2002 study showed that orthopedic surgeon’s ties had the same bacteria found in wound infections of patients.  Ok, so I don’t wear a white coat or a tie… am I safe?  Well, as a resident I wore scrubs and one 2011 study showed that 60% of hospital nurse and physician uniforms are colonized with bacteria.  The good part about wearing scrubs, even if colonized with bacteria, was that when I came home I immediately took them off and washed them.  In contrast, I now wear my regular clothing to work and the divide between home and work attire is more blurry.  While in general my work clothes are separate from my everyday leisure clothes, there is definitely some cross-over.  There are also many times when I go straight from work to events or activities with my children, exposing them to whatever is still on me.

While I found many studies suggesting that there are bacteria all over my clothes and ID badge, there isn’t anything that explains what risk there is of this bacteria causing infection in others, whether patients or my children.  Instead of worrying about what I am wearing, the Society for Healthcare Epidemiology of America (SHEA) suggested, in a 2014 JAMA article, a few tips, including being bare below the elbows, washing hands, and cleaning stethoscopes and ID badges regularly.

So, if I try to be bare below my elbows (which I often do by pushing up my sleeves), avoid white coats and ties, clean my accessories, and wash my hands, then does it matter what I am wearing beyond that?  Well, one 2004 study in the Journal of Infection Control looked at how different fabric materials carried pathogenic bacteria and found that polyester, acrylic, and wool were much worse that cotton (> 80% vs < 10%).  Great… more reason to justify my cheap, cotton t-shirts.  How do patients feel about my casual, cotton bare-below-the-elbow attire though?  Turns out that in the UK, where white coats are banned, patients have reported preference for scrubs in inpatient settings and formal attire in outpatient settings, however, preferences changed once patients understood why these policies were in place.

I have worked in settings with a variety of dress code restrictions due to this issue, including a ban on white coats, wedding rings, and open-toed shoes.  While my current work dress code is flexible, I tend to take a middle of the road approach and follow many of the recommendations of SHEA.  As a pediatrician, I also think about the risk of bringing home things like lice and scabies, so I often have a no hugging and no hair touching (mine, not the patient’s) policy.  Overall though, I worry less about what I’m wearing when and more about hand hygiene.  I would encourage everyone to wash their hands more this Fall and rest assured that I will too.

Tuesdays with Mommy: At the Doctor

breastfeeding_at_doctorAlthough I enjoy my Tuesdays at home as a day to play with the kids, it feels great that when one of them is sick on a Tuesday, I can be there to take care of them.  After returning to school this September, it was inevitable that one of them would catch something.  It ended up being little G who caught croup, so we spent the day taking walks in the cool air, basking in the cool mist of her humidifier, and wrestling pursed lips to get some Ibuprofen in.

As a doctor, I find it hard not to think of the worst case scenario.  The first night of her illness, I played out possible scenarios in my head.  If her breathing worsened and we had to go to the hospital, who would watch my son?  Would I drive or call 911?  I found myself preparing the diaper bag so that I could leave the house in a hurry, if needed.  While her illness never progressed to that level of severity, we did end up in the doctor’s office the next day.  I had already anticipated what the doctor would do for her and I found myself calculating her steroid dose in my head.  I estimated how many pounds she must weigh by now… converted to kilograms… multiplied by 0.6.  It was dirty math, but I figured about 5 mL would be necessary.  Later on when the doctor did the official calculations, she told me it would be 5 mL and I stifled a smile.  It was hard to disconnect from my work.

I have seen dozens of children with croup in the Emergency Department and admitted to the hospital.  The management of these children is so standardized and routine that it rarely raises any alarm and could be completed by any intern.  However, holding my own stridulent daughter made me question every noise I heard and develop paranoia.  Was that stridor?  Is she congested or wheezing?  Is she belly breathing or does she always breathe like that?  I seemed to lose my objectivity.

I was once again happy that I am not her doctor and that although I knew what all the appropriate steps were to treat her, there was someone else there to make those decisions for me.  While I don’t want to spend my day off at my office, I was glad that my colleagues were there to help me care for my daughter during her illness.  After G recovered from her episode of croup, I developed more empathy for the parents I see with children in the same situation.  Another example of how parenting humbles me and informs my pediatric practice.

Saturday in the City

It is not a secret that most parents are home on a Saturday night and while I recognized how boring my weekend evenings have become, it was not until recently that I remembered what others were doing while I was home.  Typically after a long day of playing with the kids, my Saturday nights are quiet and restful.  A few blocks away, there are bars and restaurants that I know are bustling, but they feel far away in distance and time.  It has been awhile since I was there to see it for myself.

On a recent Saturday night, I realized that I needed to buy some milk, so I offered to N that we take a walk to the local Rite Aid before he went to bed.  As we walked, we passed couples holding hands, friends feeding their parking meter, a group of girls waiting for their table at a local Italian restaurant, and a double-date inspecting a bottle of wine before handing it to the waitress.  There was so much Saturday-night-in-the-city energy that it reminded me for a minute that oh yeah, this is what people do on Saturdays.  Meanwhile I walked to Rite Aid wearing denim covered in baby food purees and holding my toddler’s mysteriously moist hand.

N talked me into buying some chocolate Tastykake cupcakes and we sat on the concrete steps eating them, watching the lively city around us.  It was one of those warm September nights with a bit of chill when the wind blows and an earlier darkness that reminds you that Fall is coming.  I sat there appreciating this moment with my son and recognizing how quickly things change: seasons, people, life.  As we watched more people trotting off to start their Saturday nights, we finished our cupcakes and headed home to bed.  As we walked home hand-in-hand though, I smiled, thinking about how lucky I was to have the best Saturday night date in all of Philadelphia.

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