By Jade Le, M.D., chief of infectious diseases at Access TeleCare
Hantavirus and Ebola have dominated healthcare headlines recently, generating concern across the world, all too reminiscent of the early days of COVID-19.
Thankfully these infections don’t share the same transmissibility as SARS-CoV-2 and carry less risk of escalating into a global pandemic. However, what they have in common is that they do not respect geographic boundaries. They are showing up in travelers crossing borders into other countries.
Global Prevalence
There are individuals in 10 states in the U.S. being monitored for hantavirus after being potentially exposed on the cruise ship MV Hondius. Residents of the United Kingdom, Turkey, Sweden, Germany, and New Zealand are also being monitored. I’ve recently been asked to weigh in on the hantavirus situation on The Will Cain Show on Fox and other outlets.
Ebola, declared a Public Health Emergency of International Concern by the World Health Organization, is confirmed in individuals in the Democratic Republic of Congo and Uganda. I’ve also weighed in on that outbreak here and here.
Global Threat
With the world’s biggest sporting event, the FIFA World Cup, kicking off June 11 and taking place in three different countries in 16 different cities, the global threat is significant for additional viral spread of these infectious diseases and others, including SARS and other coronaviruses, Mpox, measles and other vaccine-preventable illnesses, tuberculosis, Hepatitis A, dengue, malaria, sexually transmitted diseases, and gastrointestinal pathogens such as norovirus.
These are the infectious diseases we know of. New infections are constantly emerging. Over the last 20 years, 30 new infectious diseases have emerged, telling us we must be vigilant to new infections.
An infectious disease outbreak of a known pathogen, or an unknown one, which starts on one side of the earth can cross the ocean in just one plane ride.
Early detection, identification, and containment are critical.
A Need for More Infectious Disease Expertise
While the need for infectious diseas and public health expertise to detect, identify, diagnose, manage, and contain infectious diseases, 80 percent of counties in the U.S. do not have a single infectious diseases specialist available. That means that a patient presenting unusual symptoms at his or her community hospital may be misdiagnosed, losing valuable time for appropriate treatment, possibly with serious, or even fatal, consequences.
In addition, delays in deployment of proper infection control measures may lead to additional nosocomial spread, putting healthcare workers at risk of contracting these potentially deadly infectious diseases.
That’s where the power of telemedicine comes in. Having immediate access to an Access TeleCare infectious diseases expert means hospitals are always prepared to treat uncommon or unusual infectious diseases cases, with rapid implementation of infection prevention measures. With a teleInfectious diseases program, hospitals anywhere in the country have almost immediate access to specialty consultation for expert diagnosis and treatment. Having an experienced infectious disease expert on the clinical team can mean the difference between a successful diagnosis and a patient waiting days or longer for answers or requiring a transfer for such expertise.
A teleInfectious diseases program serving a local hospital not only provides immediate access to expert clinical consultation, it provides national perspective. Access TeleCare’s infectious disease specialists care for patients all over the country. On any given day, we may round on patients in Arizona and Alabama. We may consult on a patient in Tennessee and in Texas. We are not limited to a single hospital in a single city or neighborhood. That gives us a bird’s eye view of where infection hot spots might emerge.
As a collegial team of infectious disease physicians, whenever we hear of any outbreaks in any of the states of the hospitals that we cover, we share that information. We might tell a physician to be on the lookout for tuberculosis in Kansas. Be on the lookout for measles in Texas, Utah, and South Carolina. Be on the alert for salmonella food poisoning in X, Y, Z states where a grocery chain recalled produce.
Likewise, we share information with each other in real-time about what might start out as an isolated, regional outbreak but has potential for national spread.
Disease Detectives
Infectious disease specialists have a unique skill set. We often think of ourselves as doctors who like to put different pieces together and solve complex puzzles. Key to that puzzle solving is asking the right questions. When we see a patient with an unusual infection, we must look beyond symptomology and ask questions like, “have you been exposed to any wild animals?” “Have you been bitten by an insect?” “Have you traveled recently? And to and from where?” We review their hospital medical records for laboratory abnormalities, radiographic abnormalities that may yield important clues to their diagnosis.
Forging a relationship with the patient, earning their trust, and having the opportunity to ask these questions give us the necessary clues that can make a huge difference in outcomes for an individual patient with important consequences for the health of an entire community or country.
A Personal Story
I became interested in infectious diseases as a Peace Corps volunteer in the mid-1990s. I served in Gabon, on Africa’s west coast. During my time there, there was an Ebola outbreak in the village I was assigned to. I saw the immense suffering this virus causes, watching pregnant women miscarry, and entire households wiped out, leading to empty villages with boarded up houses. But I also saw the equally immense power of infectious disease experts to reduce mortality, help patients get back to their homes, get back to their jobs, get back to their families, and resume their lives. The intense preparations and collaboration between the treatment teams and the public health servants helped to lower the mortality rate and eventually stop further spread.
Also at that time, I read The Coming Plague, the groundbreaking work by the journalist Laurie Garrett, based on extensive interviews with infectious disease experts in which she explores the history of epidemics and environmental changes, globalization, and human behavior that create the perfect storm for new infections to emerge and take hold.
I took away from those early experiences the deep belief that it is possible to prevent, manage, and contain infectious disease outbreaks, but we need the will, resources, and expertise to do so.
For infections that cross geographic boundaries, we need healthcare delivery models that cross them as well. Telemedicine is how we do that. With teleInfectious Diseases programs, we can eliminate geographic barriers to timely care and put the resources and expertise where they need to be.
Access TeleCare’s Infectious Disease Program
Since 2021, Access TeleCare’s infectious disease program has demonstrated measurable impact for hospitals by reducing length of stay and transfers, optimizing antibiotic use, and managing pharmacy spend. Our clinicians have diagnosed West Nile in a patient thought to have encephalopathy due to sepsis, hantavirus, tuberculosis, histoplasmosis, coccidiodomycosis, acute Hepatitis A, acute Hepatitis B, salmonella, plague, HIV/AIDs, malaria, and a rare autoimmune condition in a patient being incorrectly treated for tuberculosis.
Contact us to learn more about staffing an on-demand infectious disease program in your hospital.
