Ebola: US beats Spain 1-0

Two cases of Ebola transmission outside Africa, one in Spain, another in the US. Similarities? Some. Differences? Many. Both countries have handled the situation very different. The big difference consists of thinking ahead and having a contingency plan ready (US) or improvising on a daily basis (Spain). We have to thank God that there are not more cases (so far) in Madrid, Spain, where the infected nurse aide Teresa Romero was isolated 7 days after reporting high fever. During this period, Teresa was going about her regular business. The US nurse was isolated 90 minutes after reporting high fever. She has been identified as 26 years old Nina Pham.

The experts knew that this would happen, sooner or later. While in the US, preparations were underway well before the transmission, in Spain nothing was done. When the contagion arises, the US had not only health plans in place but also a communication strategy ready. Panic among the population in these cases are the worst and a well prepared communication crisis management team, with a well versed spokeperson is key.

In Spain? Nothing was done for days and chaos ensued with the husband, the brother and the neighbors of the infected health care worker chatting freely with the press, while no reliable information was being produced by the Spanish government and the population panic mounted. On top of that, some authorities like Javier Rodriguez, Madrid Health Director, instead of taking responsibility for the breach of protocol, had the audacity of blaming Teresa Romero, the health care worker infected, of the contagion. The health workers collective and unions were incensed and with good reason.

SEE ALSO: Doctors hopeful for Spanish Ebola patient as condition remains stable

Some of Mr. Javier Rodriguez “jewels” to the press during the Ebola crisis:

“Nobody needs a master’s degree to know how to put on a protective suit.”

“She was not so sick if she went to the hair salon.”

The husband of Teresa Romero has asked for the resignation of Javier Rodriguez. In a letter addressed to the Spanish government and read to the media by a friend of the family he added: “She was not very sick, she only had Ebola,” in a sarcastic response to the despicable comments the Madrid Health Director made about his wife.

Meanwhile in the US, Thomas Frieden, Director of the CDC, has been quick to point out that the patient, Nina Pham is not to blame for the “breach of protocol”.

Spanish Prime Minister Mariano Rajoy has defended his government’s management of the health crisis, pointing out that mistakes have been made in the US as well. Yes, Mr. Rajoy, another case of Ebola transmitted to a health care professional but handled totally different and here is why as reported by Silvia Ayuso / Elena G. Sevillano for El Pais.

Ebola: US beats Spain 1-0

1. Protocol activation

The nurse who has just been diagnosed took her temperature twice a day, like all other health workers who came into contact with the country’s first Ebola patient. She called the hospital on Friday night, warning that she was running a “low fever.” Ninety minutes elapsed between that call and her admission into an isolated unit at Texas Health Presbyterian Hospital in Dallas.

Information regarding Teresa Romero’s activity on the days prior to her admission into Carlos III is still confusing and hard to come by. On September 30 she called the hospital’s occupational hazard department warning about a low fever, but was not told to seek medical assistance or even to stay home. According to several sources, this department talked to her again on October 2 but nothing happened. Early on October 6 she phoned the emergency number 112, but because her fever was still below 38.6º no protocols were activated. Romero was taken by ambulance to her nearest hospital in Alcorcón, where she spent nearly an entire day before being transferred to Carlos III.

2. Transfer and isolation

The nurse drove herself to the hospital. After preliminary blood tests came out positive on Saturday night, a specialized hazmat team decontaminated and isolated her vehicle hours later. These experts also disinfected all the parking areas that the sick woman may have touched on her way into the building.

In the early hours of October 6, a 112 physician and a medical assistant showed up at Ramos’ house, where she informed them of her job and situation. But orders were to take her to Alcorcón hospital’s emergency room, where a doctor named Juan Manuel Parra treated her for 16 hours almost all by himself, wearing a protective suit that left part of his arms exposed. He found out through the media that Romero had tested positive for Ebola. It was hours before a special ambulance came to collect her from Alcorcón hospital, which is not equipped to deal with Ebola cases.

3. Disinfection of the patient’s home

On Saturday night a specialized team of Dallas firefighters cleaned and decontaminated all the open areas in the apartment complex where the nurse lives. Police were deployed in the area as well.

The building where Romero lives was decontaminated on Thursday night and early Friday morning. Residents say this was very late, and asked why shared areas such as the elevator were not being cleaned. Romero’s apartment was disinfected on Wednesday, two days after the nursing assistant was taken to Alcorcón hospital with symptoms of Ebola.

SEE ALSO: Health care workers monitored after Texas Ebola case

4. ID of contacts

When a man who had been to Liberia developed Ebola in Dallas, the CDC sent a team of 90 specialists to the city, including dozens of detectives, with the mission to track down all possible contacts he may have had in recent days. After the second case emerged in a person who was not part of the group under surveillance, the CDC sent even more personnel to Dallas.

The Madrid health department conducted epidemiological surveys by telephone and door-to-door among the health workers who treated her, relatives and people that she had contact with, including two beauticians at a hair salon. How long it took to draw up the list and issue instructions is not known.

5. Monitoring of contacts

Around 48 people are being monitored at home over the first case of Ebola, following CDC protocols. None of them have shown any symptoms to date. The new patient was not part of this group. All personnel who cared for the first patient are considered to have been exposed to Ebola.

The criteria has changed over time. Ar first, people were told to take their own temperature twice a day and try to remain at home. But professionals such as the doctor who treated Romero at Alcorcón hospital insisted that people should be allowed to go to Carlos III for voluntary isolation. Fifteen individuals have decided to take this option. So far none of them have shown any symptoms of the disease.

6. Neighbors

Authorities say that they “knocked on every door on that block” to explain about the situation and the measures being taken, so that residents would not be alarmed.

Residents of the block where Teresa Romero and her husband – who is also under observation at the hospital – own an apartment have been growing angrier by the hour over what they feel is a lack of information. Many of them found out about the situation on television, despite the fact that the mayor of Alcorcón was at the hospital for five hours while the nursing assistant remained in observation there. Alcorcón authorities have since said that the home has been walled up with plasterboard for safety.

7. The dog

Dallas authorities said they believe there is a pet inside the nurse’s apartment and that it is showing no signs of infection. Mayor Mike Rawlings said there is an action plan, although no details have emerged yet.

The public found out that Romero and her husband had a dog named Excalibur when he started an online campaign to save his pet, after he was informed by Madrid authorities that they wanted to put him down for safety reasons. After hours of uncertainty and protests outside the couple’s door, the regional government went ahead with the euthanasia.

SEE ALSO: Dallas Nurse Who Cared For Duncan Contracts Ebola: ‘Inadvertent Breach Of Protocol’

8. Informing the media

No more than 12 hours elapsed between the first positive tests and the first press conferences. In Dallas, the mayor, a county judge and a hospital representative spoke with the media, as did CDC director Thomas Frieden in Atlanta.

For days there was no designated spokesperson and health authorities failed to deny all the phony stories and hoaxes that soon began spreading online. When Health Minister Ana Mato first appeared before the press, she failed to convey a sense of calm or of being on top of the situation. Deputy Premier Soraya Saenz de Santamaria finally took over on Friday, and since then releases have been issued periodically, with health experts taking questions from reporters.