The Devil You Know vs. The Devil You Fear

During Ebola, a consistent concern was that healthcare workers could bring the pathogen home because of suboptimal infection control. This concern formed part of the rationale for sequestering patients with Ebola-like symptoms at designated facilities adept at infection control—a protocol I strongly endorse.

However, the idea that only headline-grabbing contagions can be transmitted by healthcare workers gives rise to a serious threat misperception. Consider these statistics:

It is not a stretch to assume that a proportion of healthcare workers are also colonized with carbapenem-resistant enterobacteraciae and multi-drug resistant Acinetobacter (which contaminated 9% of gloved healthcare workers hands in one study). And you know how well we all wash our hands.

These individuals serve as vectors for household and community transmission of these epidemiologically significant organisms that kill thousands annually. Yet when it becomes public knowledge that someone has cared for an Ebola patient, panic ensues, which results in political pressure to implement non-evidenced based interventions, like excluding the children of healthcare workers from school.

This kind of threat misperception hampers every outbreak response as public health authorities act increasingly to placate a panicked public and their elected officials, yet fail to place risk in its proper context.

In reality, the bigger threat to the human race is not Ebola or some exotic virus lurking on the hands of the nurse or doctor dropping off their child at daycare or school (which hopefully has high vaccination rates), but rather the usual suspects. that have proven, time and again, to be much more prolific threats to the human race.  While my aim is not to incite panic over what might be on healthcare workers’ hands, I do believe a little dose of reason goes a long way towards gaining a proper perspective of contagion risk.