Ebola Control Measures and Inadequate Responses

The title “Is respiratory protection appropriate in the Ebola response?”1 suggests that a critically important hypothesis regarding transmission of Ebola will be discussed. Instead, in their Letter,1 the authors assert that direct contact precautions advocated by the US Centers for Disease Control and Prevention, are sufficient, and argue against more conservative infection control measures. Despite their insistence that conservative respiratory precautions are not needed, such measures are publicly and repeatedly shown during the repatriation of infected health-care workers to specially equipped medical centres, rather than to any hospital practising direct contact precautions, reinforcing a serious inconsistency between recommendations and practice.

In the practice of evidence-based medicine, patients are afforded the most conservative interventions until alternatives are substantiated through rigorous scientific methods. When confronted with clinical features and behaviours that defy our expectations, predictions, or understanding, clinical scientists build testable hypotheses around those observations and in the interim protect patients, their caregivers, and contacts with the most conservative precautions. Our present reality concerns an expanding number of clinicians who were infected while ostensibly observing the direct contact precautions. No evidence has been provided to the contrary. Ebola observers can deduce the epidemiological implications of aerosol transmission described in extant literature, and mentioned although not referenced by Jose M Martin-Moreno and colleagues in their Letter.1 Accordingly, hospital administrators will enact more conservative precautions that either the authors1 or the Centers for Disease Control and Prevention have prescribed.

Scientists should make undiluted risk assessments and serious plans to contain, detect early, and actuate meaningful health-system responses to Ebola infection.

The scientific community must argue for the most conservative infection control responses that make sense in light of the present data. I believe the authors1 and the Centers for Disease Control and Prevention have failed to do that and in so doing, have imperilled individuals unnecessarily.

I declare no competing interests.

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