Nothing strikes fear into our hearts like the threat of a deadly disease.
In 1992, my first semester in Yale’s School of Public Health, I took an epidemiology class in which groups were assigned a mystery disease project. We were given bits of information and told to determine how to respond without yet knowing which disease this was. That project was based on an outbreak in 1976 in Yambuku in then-Zaire, of a disease affecting mostly pregnant women. Eventually the disease was identified as Ebola Hemorrhagic Fever. Turns out it wasn’t that pregnant women were particularly susceptible, it was that pregnant women were going to a health care clinic to receive injections to protect against malaria – to which they were very susceptible – via the same needle that had been used for all patients, one of whom was a teacher from the Mission’s School who had recently returned from a remote area.
That’s right – one needle.
Much has changed in the 38 years since that 1976 outbreak. Little has changed.
Ebola convinced me to be an epidemiologist, and during my time at Yale another outbreak occurred in Africa. Some of my professors joined the Center for Disease Control and Prevention (CDC) and World Health Organization (WHO) teams to investigate. A lowly student, my job was to help pack crates of supplies for the teams, and to listen and learn from their stories upon their return. Ebola has always been near and dear to my heart in the way only a fellow epidemiologist can appreciate.
Twenty more years, more outbreaks, and now, the biggest one ever has happened, and it’s striking fear into the hearts and minds of Americans.
A case of Ebola was confirmed in Dallas on Tuesday. Yes, Ebola, here, in the U.S. In our state! Headlines and cable news anchors have been trumpeting the news: EBOLA IN THE USA!
The point the headlines gloss over is that the patient didn’t acquire Ebola here in the U.S., and very likely did not give it to anyone else in the U.S. The sick patient traveled from Liberia, where the outbreak is raging.
Ebola isn’t like measles or flu. You don’t get it while sitting next to someone on an airplane, or in an office. It isn’t highly contagious when a person isn’t showing symptoms. It is spread via direct contact with the sick person’s bodily fluids, and a patient is not infectious until symptoms develop – only then does it become highly contagious.
The patient in Texas developed symptoms four days after arrival in the U.S. and sought medical treatment within two days. Other passengers on the same flight as the patient are not likely at risk. Most of the people in Dallas who may have been in contact with the patient are not at risk. Those living in the same household or who have had very close personal contact wit the patient have cause for concern and are already under the care of expert health care providers.
We in the U.S. should be more concerned about measles than Ebola, which is to say, not very much if we’ve taken appropriate precautions. We can take comfort in the knowledge that the patient sought medical care within 48 hours of becoming ill, and more importantly, that the patient had access to medical care. This is the key.
Ebola is a tale of the continual struggles of poverty. The 50% fatality rate is largely due to lack of infrastructure: no roads to travel to the few health care facilities that exist. Those that exist are not well stocked with staff or supplies. There are civil wars, there’s crushing poverty. In 1976, the outbreak began due to a clinic using one needle for multiple patients. While that practice has mostly subsided, the lack of supplies continues to be a problem. Poverty and civil wars are still a problem. In the four countries hardest hit in the current outbreak – Sierra Leone, Guinea, Liberia, Nigeria – the poverty levels are more than 70%.
Much has changed, yet little has changed.
Treatment for Ebola is mostly symptomatic – you try to treat the symptoms so the patient can stay strong enough to fight off infection on his or her own. An average 50% fatality rate is enormous. This is the scary part, but it can be prevented. Local customs – such as burial practices that involve community members cleaning and shrouding the body, which can put contact with the fluids and linens that have been contaminated – contribute to the spread. Using proper personal protections, such as gloves, gowns, and masks, all help.
In places like the Médecins Sans Frontières/Doctors Without Borders‘ Donka Hospital in Conkary, Guinea, there are only so many beds available. Not everyone can get medical care. The aid organizations and their workers who are on the front lines of these outbreaks are amazing in their dedication and skill, but they can’t simply overcome the problems that created this crisis.
It’s telling that the three patients who have been flown to the U.S. have survived. They had access to the highest level of medical care. That no health care worker in the facilities in which they were treated became infected is also telling.
Back in Texas, having worked closely with the Texas Department of State Health Services (the CDC release refers to it as Texas Health Department) experts who are involved in this current situation, I have every confidence that they are working around the clock to identify any potential contacts, provide testing for them all, and isolation if they feel it’s necessary. Scenes from the film “Contagion” are not likely to become a reality, thanks in part to these people who work quietly behind the scenes to prevent it from happening.
Ebola should make us concerned – concerned for those people in West Africa with little health care, living in poverty, with no real infrastructure. It should make us concerned for what could happen in the U.S., if we ever let our health care infrastructure unravel.
Should we panic? No. We should focus on those things that keep us healthy – eating well, exercise, vaccines where possible, education, health care, infrastructure. All these create a healthy community.
*Featured/top image: Joanne Liu, international president of Doctors Without Borders, and a health advisor visit the Ebola treatment center in Kailahun, Sierra Leone. Photo by P.K. Lee/Doctors Without Borders.
This story was originally published on Thursday, Sept. 9.