Most Read
Image 01 Image 02 Image 03

Any lessons from Ebola in the US?

Any lessons from Ebola in the US?

We could learn. But will we?

Fortunately, we haven’t had very many Ebola patients in the US so far. But there have been quite a few interesting things to note about the group of patients we have had.

The first is that all of them except Thomas Eric Duncan seem to have contracted Ebola while caring for other Ebola patients. And if “carrying a woman to a cab to go to the hospital” is defined as “caring for,” that would include Duncan as well.

Note that I wrote “seem to have contracted Ebola while caring for other Ebola patients.” That’s because Dr. Rick Sacra, who contracted Ebola in Liberia, was not caring for known Ebola patients at all; he was treating pregnant women.

So we must conclude that both Dr. Sacra and the staff at the hospital where he worked in Liberia, although they are medical professionals in a country currently experiencing an epidemic of the disease, have encountered patients who are ill enough to transmit Ebola to others.  Yet, their symptoms are either not serious enough, or are atypical enough, that their Ebola status has gone unrecognized by the medical people treating them.

Dr. Sacra’s case is a sort of mirror image of Thomas Eric Duncan’s case.  Duncan also helped a pregnant woman who was not known or recognized to have Ebola at the time but who turned out to have been highly contagious. This fact sequence points out something that health professionals here have mostly been mum about: although Ebola is an extremely serious and often-lethal disease, it is not always recognizable as such, even by highly-trained (including Western) doctors and nurses.

There are many reasons for this (one is that what we think of as “typical” symptoms are not present in a significant number of cases), but for our purposes right now it’s enough to state that it is a troubling fact.

Another pattern that leaps out is that so far the death rate in the US has been much lower than in other places. This even includes the US citizens who got their initial treatment in Africa and were only flown here after they had become quite ill.

The good results might just be a coincidence, because the number of patients treated here has been very, very small. But if we assume there’s something to it, it could be some combination of early treatment (for about half the patients here, anyway), the high quality of our medical care in general (effective rehydration, etc.), and therapies which seem to include antiviral drugs and survivor transfusions.

The only Ebola death in the US so far has been Thomas Eric Duncan. He missed having the advantage of an early diagnosis because his case went unrecognized by the Dallas hospital ER he first visited.

He also had the misfortune of not matching the blood type of the available survivor donors, so he didn’t receive a transfusion from any of them. It’s also possible there was something different about his physiology; perhaps other illnesses had weakened his immune system, or there could even have been genetic factors that made him more susceptible to the illness.

It may be that we risk becoming a little too cocky, though, about our ability to treat Ebola. Our success so far appears to depend in part on the tiny number of cases. It wouldn’t take much to completely overwhelm our ability to give patients the sort of care these first victims have gotten, and then things could change dramatically.

What’s more, the fact that almost all the cases here have been among health care professionals caring for already-diagnosed Ebola patients is in a strange way a tremendous advantage, because it has enabled us to monitor them from the start and to treat them almost the moment they display symptoms—symptoms that in a person not known to have had prior contact with Ebola would cause no alarm. That, in turn, has two advantages: early treatment almost certainly makes it more likely that they will survive, and early isolation makes it less likely that they will spread the virus into the general public (or to other health care professionals, who will be wearing protection almost from the start while treating them).

A nightmare scenario would be if Ebola were to get out into a population that was unaware they had been exposed to it, and who therefore could easily interpret early symptoms as commonplace flu and therefore would be far more likely to infect others in the public before being diagnosed.

That’s the way Ebola could get out of control in this country. And that is why so many people (including me) are in favor of quarantining returning health care workers, and placing a moratorium on the issuing of visas to citizens of the Ebola-affected countries of West Africa, except in compelling circumstances.

This is not because we are unaware of the fact that Ebola is alleged to be contagious only in symptomatic individuals. It is because we realize that symptoms are not always heeded right away, the contagion is a continuum rather than an “off/on” phenomenon, and that there is a small percentage of African Ebola cases where there has been no previous known contact with a symptomatic ebola victim.

Being extra-careful makes sense, because the stakes—and the risks if things get out of control—are tremendously high.

[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]

DONATE

Donations tax deductible
to the full extent allowed by law.

Tags:

Comments

Neo, another factor in the low mortality we’ve seen in the U.S. COULD be the mutation of the virus we’ve seen here into a less virulent form.

We always think in terms of Ebola being a horror and one that wants to get worse. It could be a horror that sometimes gets slightly less horrible.

Saudi Arabia bans Ebola-stricken countries from hajj pilgrimage. The Saudi government has banned the entry of travelers from three countries currently dealing with the Ebola epidemic: Liberia, Guinea and Sierra Leone. The decision to reject visa requests from these countries has affected 7,400 people, according to the Associated Press.

http://www.pbs.org/newshour/rundown/saudi-arabia-bans-pilgrims-ebola-stricken-countriespilgrims-ebola-stricken-countries-banned-hajj/

“As a physician with 15 years’ experience in West Africa, and a recent Ebola survivor myself, I have both professional and personal insights into the likely consequences of such quarantine orders… We have no scientific evidence to suggest that a quarantine policy will reduce Ebola cases in the U.S. What we do know from scientific data is that individuals without fever or other symptoms cannot spread the virus.” — Dr. Rick Sacra
http://www.montgomeryadvertiser.com/story/opinion/contributors/2014/10/31/dr-rick-sacra-ebola-quarantine-policy-wrong/18261341/

    Walker Evans in reply to Zachriel. | November 3, 2014 at 7:00 pm

    We also know from scientific data that Ebola requires bodily-fluid contact to spread and is definitely not capable of aerosol (ie, airborne) transmission.

    OOPS! The CDC now admits that it IS aerosol passed; the original science was wrong. Since symptom detection seems a bit, shall we say, tentative, with Ebola patients, a quarantine does appear appropriate. The consequences of missing Ebola’s “Typhoid Mary” would be devastating.

      Walker Evans: The CDC now admits …

      CDC, (November 1, 2014): “There is no evidence that Ebola is spread by coughing or sneezing. Ebola is transmitted through direct contact with the blood or body fluids of a person who is sick with Ebola; the virus is not transmitted through the air (like measles virus).”
      http://www.cdc.gov/vhf/ebola/pdf/infections-spread-by-air-or-droplets.pdf

      tom swift in reply to Walker Evans. | November 3, 2014 at 10:42 pm

      People assume that “fluid” is a synonym for “liquid”.

      Unfortunately, gasses are fluids too.

      Therefore, “contact with bodily fluids” is consistent with transmission (via any of several distinct mechanisms) through air.

        tom swift: Therefore, “contact with bodily fluids” is consistent with transmission (via any of several distinct mechanisms) through air.

        CDC: “the virus is not transmitted through the air (like measles virus)”

    Ragspierre in reply to Zachriel. | November 3, 2014 at 7:04 pm

    What we do know from scientific data is that individuals without fever or other symptoms cannot spread the virus.” — Dr. Rick Sacra.
    *************************

    Except that is simply WRONG. We “know” nothing of the kind.

    And what we ALSO know is that if someone IS quarantined AND they become symptomatic, there is a much greater chance of preventing contact with other people.

    Unless, of course, you are an idiot.

      Ragspierre: We “know” nothing of the kind.

      The disease has been around for decades, and experts in the field say there is no evidence Ebola spreads by anything other than through bodily fluids. Indeed, all the recent cases in the U.S. were people who were attempting to help people who had active symptoms.

        Ragspierre in reply to Zachriel. | November 3, 2014 at 7:46 pm

        Well, Zachie, you are as full of crap about this as everything else you come here to pretend some expertise about.

        Quite a few people who have had the disease affirm they have no idea how they got it. You knew that, right?

        “Bodily fluids” are a very broad set of things, and they certainly CAN move, and they certainly CAN persist.

        And, while we’ve had Ebola for a while, the epidemiology of the thing is NOT well documented. A lot of the “data” is of dubious quality, or did you not read that on your moonbattery sites?

        In your perfidious preening pedantry, you really show what a moron you are. You don’t have to. You seem compelled to it somehow.

          Ragspierre: you come here to pretend some expertise about.

          Not at all. Rather, we provided citations to experts in the field.

          Ragspierre: Quite a few people who have had the disease affirm they have no idea how they got it.

          Sure, but the process of collecting the information in rural areas of Africa are less than precise. But doctors have been working with Ebola for a long time, and those that do know that they can’t be infected without contact with bodily fluids.

          For instance, it isn’t necessary to use medical equipment to prevent infection as long as you don’t have contact with contaminated bodily fluids. You can stand several feet away and be safe.
          http://abcnews.go.com/Health/clipboard-man-hazmat-suit-ebola-flight-explained/story?id=26235850

          Ragspierre: “Bodily fluids” are a very broad set of things, and they certainly CAN move, and they certainly CAN persist.

          Sure, which is why sanitizing areas of contact with someone who is symptomatic is essential.

          Ragspierre in reply to Ragspierre. | November 3, 2014 at 8:10 pm

          OOOOOooooohhh…

          The CHANGING DIRECTION CONSTANTLY “experts”.

          You really are too funny…!!!

        Ragspierre in reply to Zachriel. | November 3, 2014 at 8:07 pm

        “Rather, we provided citations to experts in the field.”

        Not really. Dr. Sacra is NOT an “expert in the field”.

        You hand-waved at “experts in the field”, like you often do.

        I think you and your experts are in the meadow, exchanging bodily fluids, if you get my drift.

        And this is all a red herring, innit?

        The issue is that quarantines work. They would work with Ebola, just like with other diseases, to provide a very low cost, effective way to prevent what could be a catastrophe.

        Ya moron.

        tom swift in reply to Zachriel. | November 3, 2014 at 11:00 pm

        “No evidence of spreading” is not at all the same thing as “evidence of no spreading”.

          tom swift: “No evidence of spreading” is not at all the same thing as “evidence of no spreading”.

          CDC: “the virus is not transmitted through the air (like measles virus)”

neo-neocon This is a very thoughtful analysis of the facts we have available to us.

And Zachriel I follow your link and all I found was more of your opinion. Where are you hiding the scientific data that supports your claim that individuals without fever or other symptoms cannot spread ebola

    betty: And Zachriel I follow your link and all I found was more of your opinion.

    It wasn’t our opinion, but of someone who has years of field experience with Ebola.

    betty: Where are you hiding the scientific data that supports your claim that individuals without fever or other symptoms cannot spread ebola

    There have been more than 20 outbreaks of Ebola since 1976. Here’s a review article on human-to-human transmission of the virus. Follow the footnotes for the primary research.
    http://www.cdc.gov/vhf/ebola/transmission/human-transmission.html#evidence-summary

    tom swift: Here’s a good one from two years ago –
    http://healthmap.org/site/diseasedaily/article/pigs-monkeys-ebola-goes-airborne-112112

    From your link: “What do these findings mean? First and foremost, Ebola is not suddenly an airborne disease.”

    Ragspierre in reply to tom swift. | November 4, 2014 at 8:40 am

    Zachie is here today with a new school of red herrings.

    Who said it was air borne?

    The issue is STILL quarantine.

      Ragspierre: Who said it was air borne?

      See above.

      The other issue of concern is when Ebola becomes infectious. The science indicates it only becomes infectious upon onset of symptoms, and is most infectious in late stages of the disease. Hence, isolation and sterilization of the environment is important, but quarantine is not effective.

      There have been 20 outbreaks of Ebola since 1976, so the medical researchers have a lot of data concerning the disease.

        Ragspierre in reply to Zachriel. | November 4, 2014 at 9:23 am

        You are full of crap, Zachie.

        As the experiences of Nigeria show.

        As the sound public health policy of the several governments around the world demonstrates.

        And as BOTH the CDC and the U.S. military have determined.

        Quarantines are a low-cost, effective means of curbing transmission and potential transmission.

        Why do you bother to come here to bloviate?

        Serious question.

          Ragspierre: As the experiences of Nigeria show.

          Quarantine makes more sense in Nigeria as medical centers are rare and transportation is difficult, so if someone has been exposed, if they leave the area, they may become symptomatic far from help.

          Furthermore, quarantining medical workers from developed countries who are returning from the fight against the disease at its epicenter will tend to reduce the availability of such medical workers. If it were medically indicated, then sure, but it’s not.

        Ragspierre in reply to Zachriel. | November 4, 2014 at 9:55 am

        But you wouldn’t know “medically indicted” from your own ass, would you, Zachie?

        And you have absolutely NOTHING to back up the ASSumptions you fling.

        So. Again, why do you come here to preen and bloviate, when you really are only succeeding in making a fool of yourself?

In America, soap is easy to obtain. And, people shower and bathe often. Some people shower daily. This is NOT true in Africa! Especially where you have ebola, soap is lacking. Plumbing is lacking. And, even bleach has been known to be lacking.

Now, at Bellevue, which did get an ebola patient, nursing staff responded by calling in sick. How sick? “Feverish.”

Our government tells you one thing. But your eyes tell you something else.

How come you can’t answer the question about your OWN sickness, Zackie.

We all see it. You should deal with it.

“The individual should be ensured, through public health orders as necessary, to undergo direct active monitoring, have restricted movement within the community, and not travel on any public conveyances.”

Yes. Quarantined. With orders as necessary.

Ya moron.

    Ragspierre: The individual should be ensured, through public health orders as necessary, to undergo direct active monitoring, have restricted movement within the community, and not travel on any public conveyances.

    That is incorrect. For instance, Kaci Hickox won a court order against quarantine, which means she can meet with people, but is still under active monitoring.

      Ragspierre in reply to Zachriel. | November 4, 2014 at 11:44 am

      We’re all pointing a you and laughing, Zachie.

      Whadda moron…!!!

      Why do you insist on doing this to yourself? THAT’s a question for a professional, btw.

Font Resize
Contrast Mode
Send this to a friend