Dr. Darina O'Flanagan:

On the question on respirators and the evidence of airborne transmission, the only studies that have shown airborne transmission were done in animal testing. There has never been any evidence of airborne transmission of Ebola between humans. Previous studies have looked at family members and at who got it and who did not and it is the people who have direct contact with the bodies and bodily fluids. All the evidence points to direct contact.
The only time we are worried about aerosol is, as Dr. Holohan said, in relation to aerosolising procedures, like intubating the patient. Those procedures are not done in general practice. Respirators and FFP3 masks are available in hospitals where there is the potential for aerosolising procedures. The FFP3 masks stop aerosols just as much as powered hoods. Staff have FFP3 masks. If they wish to use a powered hood, that is possible, but is not necessary according to guidance from CDC, the WHO, etc. Obviously, the transmission in the recent cases in Texas and in Spain has caused concerns among health care workers, so CDC is very carefully looking at where there was potential breakdown in regard to personal protective equipment, PPE. These issues will be fully examined and lessons will be learned, but the initial information coming out is that it may have been more a problem when people were taking off the PPE rather than the effect of the PPE when they were actually wearing it. The most dangerous time for a health care worker is actually taking off PPE.
The other thing I would like to stress is that patients become more infectious the more the disease progresses. When patients present to GPs or in emergency departments, they do not have the same viral load they have when the disease progresses and they are extremely ill. The greatest risk to health care workers is when caring for cases in extremis. People have to be aware of that. I can understand the concerns of health care workers but where we need to make sure people have this right is in terms of health care workers who are handling the extremely ill patients who, as Dr. Holohan said, are producing copious amounts of bodily fluids. That is the time when they are most infectious.
As was said, people are using the buddy system and are making sure that when they take off the PPE, they are doing so appropriately. Those systems are being practised and are being put in place for those who will handle the really critically ill patient.