From Foxtrot Alpha: Ebola is deadly and can spread, but with precise prevention measures, the spread of the virus in America is extremely unlikely. The two Americans headed home will be able to get the best care available, and the factors leading to the spread in West Africa will not be in play here.
Ebola is deadly and can spread person-to-person, but with the precise infection prevention measures that will be in place with the CDC, the spread of the virus in America is extremely unlikely. The two Americans headed home will be able to get the best supportive care available for them and the factors leading to the spread in West Africa will not be play in here.
Let's frame this Ebola outbreak for those of you who have been hiding under a rock. We are currently seeing the worst Ebola virus outbreak ever, and it's taking place in West Africa. Over 1300 people have been diagnosed with the infection and recent counts put the death tolls at 729 so far. Citizens of Liberia, Sierra Leone, Nigeria, Guinea and American healthcare workers have fallen ill with Ebola hemorrhagic fever and there has been some controversy over the decision to fly two Americans home for further care.
I think that fear is unwarranted and here's why.
Ebola is a filovirus, one of the most virulent pathogens in the field of infectious diseases, and dangerous enough that it has been considered as a potential bioterrorism weapon. The virus can incubate for up to three weeks and for that time the patient is not thought to be contagious. It is deceptively vague in its early symptoms which include fevers, muscle pain and fatigue. Later, the deadly symptoms begin which manifest with bloody, copious diarrhea, bloody urine, easy bleeding and shock.
However, notice I said it was one of the most virulent pathogens, I did not say it was the most contagious. This means that it is a dangerous virus once you get it, but the spread of it is not entwined in this definition.
In fact, the flu, the common cold and that famed cruise ship diarrhea (norovirus), are all much easier to spread than Ebola. Even in terms of deadly contagious viruses, the avian flu and the recent famed MERS (Middle East Respiratory Syndrome) would be higher on the list of things to worry about before Ebola virus.
While there is no treatment for Ebola at this time, supportive care is the best that we can offer patients and the best supportive care in the world is here in the United States. The care they will receive will depend on their condition but may include helping the body replenish its ability to clot through blood products, which may stave off symptoms of hemorrhage.
Keeping blood pressures up with potent medicines like norepinephrine and assisting the circulatory and respiratory system with intubation are also parts of supportive care and are offered when needed. This is all to help the patient's own body focus on fighting the viral infection with its own immune system. The medical team in Atlanta may also consider giving intravenous immune globulin therapy or plasma exchange in an effort to flush out some of the inflammatory effects. The care that these Americans will receive here would not be able to be matched in West Africa.
The infection control measures that will be in play for the healthcare workers taking care of these patients will include wearing gloves, a gown, eye protection and disposable shoe covers and even full respirators if a procedure is planned. These general measures are the same that are being used by non-governmental organizations like Doctors Without Borders/Médecins Sans Frontières in the field in West Africa, but the spread of virus there is more likely due to some patients not making it into hospitals and dying at home, poor infection control measures at smaller facilities and the African rituals around burying family members.
It is not known how long the virus can survive on contaminated surfaces and dead bodies, but it is longer than other viruses and has been reported to be at least several weeks. With the heavy infection control measures in place at Emory, there is little chance for infection spread and if it was to inadvertently spread it would be identified and handled immediately.
Once public health experts can get ahead of the virus in West Africa, and control the spread, the incidence of disease should downtrend and eventually Ebola will again hide in its still unknown animal reservoir. The leading theory is that bats may be the animal reservoir and that they infect apes and chimpanzees and occasionally through consumption of sick or dead animals leak out to infect humans and cause the small epidemics of disease that we have been able to identify since the 1970s. The animal reservoir is most likely native to Africa and this is why Ebola only rears its head in this continent.
So, as Dr. Thomas Frieden of the CDC put it, a U.S. spread of Ebola is "not in the cards." The jet that will transport these patients is equipped for the task, the CDC and Emory Hospital are fully prepared for their part in the mission and now all we can do is hope the patients who are being transported will do well.
And my message to those of you against bringing these Americans home, instead of agonizing about Ebola spreading in the US, do us all a favor and get your flu shot yearly.
Payal K. Patel M.D. is a clinical fellow in infectious diseases in Boston, MA. Her views are her own and do not represent her current or past academic institutions.
Photos: Paramount Pictures, CDC, AP