An Australian infectious diseases expert has accused the World Health Organisation of playing Russian roulette with the lives of healthcare workers fighting the Ebola outbreak in west Africa.



Raina MacIntyre, a professor of Infectious Diseases Epidemiology at the University of New South Wales, questioned health worker protection guidelines issued by the WHO and the US Centers for Disease Control in a co-authored editorial in the International Journal of Nursing Studies on Tuesday.



The guidelines recommend medical staff treating Ebola patients wear goggles and masks, but because the virus is largely transmitted through direct contact with bodily fluids and not airborne particles, they do not recommend using higher-level protective equipment like respirators.

But in controversial comments MacIntyre said this was a mistake, with 120 healthcare worker deaths reported during the ongoing outbreak so far, which is also the worst recorded.



“I have conducted the world’s largest randomised control trial of respirators and surgical masks, and it is concerning to me that we are dealing with a disease which has a fatality rate of up to 90% and yet we are not taking the most cautious approach,” she said.



“If our healthcare workers die we have no hope of controlling the outbreak. There has been no criticism of the guidelines but lots of commentary supporting them. But they’re playing Russian roulette with frontline health workers’ lives.”



Laboratory workers researching Ebola were required to wear full protective gear, yet face masks and goggles had been deemed adequate for healthcare workers, MacIntyre said.



It was “outrageous” that scientists had one set of guidelines and healthcare workers had another, she said.



“It’s like they have no concept of what the clinical setting is like,” MacIntyre said.



“The hospital is an unpredictable, highly contaminated setting which poses higher risk of Ebola transmission.”



Her comments come as medical charity Médecins Sans Frontières accused world leaders of turning their backs on west Africa and described the international Ebola response as “lethally inadequate”.



However, MacIntyre’s comments are controversial. A recent piece in the highly respected international medical journal, the Lancet, said a rational and efficient approach to healthcare worker protection was needed.



“Excessive precautions could offer reassurance to those responding to Ebola, yet complete respiratory protection is expensive, uncomfortable and unaffordable for countries that are the most affected,” the authors wrote.



“Worse, such an approach suggests that the only defence is individual protective equipment, which is inaccessible to the general population.



“Goggles and masks might not even be necessary to speak with conscious patients, as long as a distance of one to two metres is maintained.”



It’s a view that Allen Cheng, an associate professor with the Department of Epidemiology and Preventive Medicine at Melbourne’s Monash university, agrees with.



“The issue is whether Ebola can spread via an aerosol route, and the overwhelming weight of evidence is that it doesn’t,” Cheng said.



“There has been quite a lot of experience from people who have dealt with Ebola outbreaks that came before this one, and while this one does seem to be a little bit unusual in terms of the number of deaths, there are a lot of other explanations for why healthcare workers are so affected.”



It could be that medical staff were not removing their masks or goggles correctly and were contaminating themselves in the process, he said, or were poorly trained.



“The other way of looking at this is there is a very limited pot of money for dealing with Ebola and we want to maximise the amount of masks and other equipment that is out there,” he said.



“I am also concerned that by criticising the guidelines people may not trust them, which could also be a real problem.”

