No, We Aren’t All Going to Die Because Ebola Patients Are Coming to US for Treatment

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Scary, color-enhanced electron micrograph of Ebola virus particles. Creative Commons license courtesy of Thomas W. Geisbert, Boston University School of Medicine.

With the death toll now over 700 in an Ebola outbreak that has been building since February, Americans are suddenly up in arms about the virus, but only because it was announced yesterday that up to two Americans infected with the virus may be transported to Atlanta for treatment. Yes, the virus is especially deadly, with a death rate of 70-90% of infected patients, but the virus does not spread particularly efficiently and is not airborne. Writing at CNN.com, biologist Laurie Garrett points out a disaster scenario for the virus. Rather than an outbreak in the US, which seems extremely unlikely, Garrett outlines how the virus could spread in the much more densely populated Nigeria rather than the more remote areas of Guinea, Sierra Leone and Liberia where it is now concentrated.

Before getting into the details of the current outbreak and its possible spread to Nigeria, a little background on the virus. From the World Health Organization, we have this information on how the virus spreads:

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Of particular relevance to the two patients who may be transported to Atlanta for treatment (they work for Samaritan’s Purse, an aid organization) and the tragic death of Sheik Umar Khan, Sierra Leone’s top Ebola doctor, the information from WHO continues:

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

The fact that these health care givers become infected because standard infection control precautions are not strictly practiced in no way should suggest that they are uninformed or careless. Instead, Garrett points out in her article the stark realities facing health care providers in the three countries where the outbreak rages:

To show how ill-equipped these nations are to battle disease, per capita spending on health care, combining personal and governmental, amounts to only $171 a year in Sierra Leone, $88 a year in Liberia and $67 a year in Guinea, according to the Kaiser Foundation.

For those who want more detail on the virus, this succinct summary of the structure of the Filovirus family of viruses and their mode of operation is very informative.

For the panic-motivated hypochondriacs among us, initial symptoms of this virus mimic the onset of most other viral infections.

The most recent update from WHO on the outbreak can be read here. The update summarizes the assistance that is being provided to the countries where the outbreak is ongoing. Significantly, WHO is not advocating travel restrictions at this time.

Returning to Garrett’s article, she points out the factors that would lead to chaos should Ebola spread in Nigeria:

Were Ebola to take hold in that country [Nigeria], spreading from person-to-person in a densely populated, chaotic city such as Lagos, the worldwide response would swiftly spin into uncharted political and global health territory.

Consider the following: Nigerian physicians are on strike nationwide; hundreds of girls have been kidnapped from their schools and villages over the past six months by Boko Haram Islamist militants — and none has been successfully freed from their captors by the Abuja government.

Nigeria is in the midst of national election campaigning. President Goodluck Jonathan’s government is, at best, weak. The nation is torn apart by religious tension, pitting the Muslim north against the Christian south. Islamists in the north have long distrusted Western medicine. They have opposed polio vaccination and have kidnapped and assaulted central government health providers.

Garrett’s plea is for an already-planned African summit on Monday to be used to develop a coordinated plan for dealing with the virus:

One way or another, Obama must take advantage of Monday’s Africa summit to press the case for calm and appropriate responses. These would include specific post-Ebola financial commitments to Liberia, Sierra Leone and Guinea.

The possibility that the epidemic might take hold in Nigeria must be confronted, and plans of action must be considered. The world cannot afford to make decisions in the heat of panic about such things as international airport closures, withdrawal of foreign oil workers, negotiations for outbreak responses with northern imams, hospital and clinic infection control training across thousands of Nigerian health facilities, deployment of international assistance teams for rapid diagnostics and lab assistance and countless other contingencies.

Sadly, Garrett points out important information on the damage that has already been done in this outbreak:

When this Ebola epidemic eventually ends, the health budgets of these nations [Liberia, Sierra Leone and Guinea] will have been bankrupted, and many of their most skilled and courageous physicians, nurses, Red Cross volunteers and hospital workers will have perished.

Let’s hope that Monday sees the beginning of stronger coordination to put more resources where they are needed to halt the spread of this ongoing disaster.

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34 replies
  1. Ben Franklin says:

    I’m not sure of the strain of ebola in this case, but in others it has gone airborne.

    http://www.the-scientist.com/?articles.view/articleNo/33277/title/Ebola-from-Pigs-to-Monkeys/

    Now two scientists from CDC are infected and they are bringing it to the US?
    If their recent failures to maintain adequate protections in US labs is any indication of the poor procedures leading to infecting this two, why should we have no concerns about transference here.

    And what prompted this legal CYA (SOTU 16 famous words?)

    http://www.whitehouse.gov/the-press-office/2014/07/31/executive-order-revised-list-quarantinable-communicable-diseases

    • Jim White says:

      .
      That’s pure bullshit. It’s not CDC scientists who are infected. It’s volunteers, as stated in the post. And the clinicians at Emory who will be treating them are first rate and unrelated to the old CDC and NIH labs that had issues. Don’t spread that kind of shit here.

  2. Ben Franklin says:

    Maybe you are a little too close to this story, Jim. Do you personally know folks in the CDC?

    • Jim White says:

      No I don’t. And you are completely over the line into lunacy to claim volunteer workers in A circa are in reality CDC scientists who turned themselves into viral suicide bombers.
      .
      You know from my anthrax work I will call out plotters in government. That is clearly not the case here.

  3. Ben Franklin says:

    “are in reality CDC scientists who turned themselves into viral suicide bombers.”

    That’s what upset you? No such thing. I’m just asking how you are so invested and confident that there is nothing to worry about. I don’t know anything about an old CDC versus the new one, but I am curious why you are so sure the new boss is not the same as the old boss.
    .

  4. Jim White says:

    .
    Specifically this bit:

    Now two scientists from CDC are infected and they are bringing it to the US?
    If their recent failures to maintain adequate protections in US labs..

    As I pointed out, these are volunteers with Samaritan’s Purse, not CDC scientists. And you put it with the failures on control. That reads to me like a hysterical conspiracy theory that CDC sent scientists out to get infected so that they could come back and spread the disease here.
    .
    What I’m trying to say about the risk factors is that this virus has nowhere near the pandemic potential of something like an influenza virus. Documented cases in human (yeah, there’s an animal study or two suggesting airborne, but no human data yet) look to me like infection comes from being around dying or dead patients. Here in the US, perhaps if Garrett’s worst case scenario happens and spread hits Nigeria, we may see a few cases from infected travelers arriving, but standard isolation procedures inherent in US healthcare won’t allow the kind of spread that happened in West Africa.

    • Ben Franklin says:

      So, you make nothing of the coincidental WH EO from yesterday? It sounds as though they wish to absolve USdotgov if anything does go wrong. I know Obama wears suspenders and belts to hold his trousers up, so this just covers the unlikely scenario of an outbreak? Try not to genuflect a conspiracy when I suggest there could be less than competent oversight. I still don’t understand how you can be so sure there is little danger.

      • P J Evans says:

        You’re panicking. Sit down, turn off your TV, your radio, and your computer, and take a nap.

    • P J Evans says:

      It doesn’t help when you get people like Trump panicking all over the media, and many people who hear stories and have no fucking clue how diseases are transmitted or why one that kills most victims isn’t as dangerous as one that’s far more contagious and far less fatal (like flu). (Short answer, for Ben, there: if it kills a lot of people, it kills off its means of transmission, so it stops spreading. Flu doesn’t kill as many of its victims, so it spreads and infects many more people. And that’s how a pandemic happens.)

  5. Ben Franklin says:

    Even if a person exhibits no signs or symptoms of Ebola, he or she can still spread the virus during the Ebola incubation period. Once Ebola virus symptoms begin, the person can remain contagious for about three more weeks.

    Incubation period is 2-21 days with the average being 4-6. Plenty of time for a Typhoid Mary to infect before the onset of symptoms. Nothing to see here folks. Move along.

    • P J Evans says:

      Dude, it requires physical contact with body fluids. It’s not contagious in any other way. This means that it’s actually harder to spread than flu or chickenpox or measles.

  6. lefty665 says:

    We’ve got sort of a checkered history with stuff getting loose from our premier establishments, Rocky Mountain Spotted Fever is one example. It did not exist on the east coast prior to getting loose from NIH. There is legitimate concern about knowingly bringing Ebola to the US.
    .
    One of the scary things about viruses is how quickly they can evolve. Acquiring the ability to spread via aerosols instead of direct physical contact is among the scariest. If that is reported in animals with Ebola, the question is, can humans be far behind?
    .
    Viral lethality and transmissibility tend to vary inversely. Crudely, the more lethal, the less transmissible. As Jim noted, it is not in the virus’s best interest to kill its hosts before it spreads. Suppose Ebola evolved less lethality with easier transmission. How would down to 50% fatalities and up 50% in ease of spread look if it got loose?
    .
    Ebola is a scary critter anywhere, horrendous in 3rd world conditions.
    .

  7. Rayne says:

    The patients definitely have a better chance here, but this is my concern:

     

    … The announcement that at least one of these Ebola sufferers will be flown to Atlanta didn’t mention who made the decision. It seems not to have been a high federal official, because the jet being used is a private charter. And just hours before it took off from Georgia, Tom Frieden, the CDC director, was talking with journalists and gave no hint of the impending action. To the contrary, Frieden stated that such an intervention might be unwise. “There is the potential that the actual movement of the patient could do more harm than the benefit from more advanced supportive care outside of the country,” he said. At the same time, he said the CDC would work with Samaritan’s Purse “to facilitate whatever option they wish to pursue.” …

     

    [Source: Bloomberg]

     

    Article’s author, Ford Vox, is described as “a doctor at the Shepherd Center for brain and spinal-cord injury in Atlanta, writes about health-care.”

     

    Somebody needs to get their shit together, stat.

  8. K.B. says:

    What if the air ambulance crashes with survivors ?. If the thing can spread
    after symptoms develop , and the vector is ambulatory then may it be transmitted via intermediate hosts like mosquito or biting flies ? I like to err on the side of
    caution . God bless those volunteers ,they knew the risks when they went to Africa.
    Take care of them abroad .

    • Jim White says:

      There are no insect hosts for these viruses. Every EMT is trained in how to avoid infectious diseases from bodily fluids and their ambulances have all the needed materials for responding to such an incident.

  9. fiddlin' Bill says:

    Me thinks Mr. Franklin is playing the troll. Perhaps it’s time to institute
    Lawyers, Guns & Money’s comment registration policy. This is an outstanding
    post and it’s a shame to see it sullied with stupid comments.

  10. Ben Franklin says:

    I think any reasonable person would have concerns. Rayne caught a glimpse of the potential. Pressure from World events puts pressure on people to make quick decisions. Sometimes they make the wrong ones.

    • P J Evans says:

      Let’s assume that everyone here is a conservative troll who can’t tolerate other views.
      Is that really the way you think, or are you normally hard-of-understanding?

      • Ben Franklin says:

        Only you and Jim attacked my assertion that this is not a safe operation, and just like obots do, you project trollery of your own when you do your damnedest to scuttle a rational discussion on the notion that only your pov is acceptable. All perception is selective and you’ve selected the version of reality that best suits you.

        Now bugger off.

      • Ben Franklin says:

        Here’s another vantage point. Go to about 16:25. Maybe it’s just a growth on his back.

  11. Ben Franklin says:

    Just saw the ambulance arrive with the Dr/patient. I note the hazmat suits had their an independent oxygen supply. Of course it’s not possible it’s airborne, as extra-special precautions are the news jibe.

    • P J Evans says:

      The photo I saw of the ambulance arriving showed people in standard biohazard suits, not ones with oxygen tanks (which, IIRC, are used with airborne hazards; Ebola is not an airborne virus).

  12. Ben Franklin says:

    “You’re not worth my time”.

    Apparently the facts are not worth your time. You have all the earmarks of an Obot troll. Has anyone; again ANYONE ever suggested this directly to you before this?

    • P J Evans says:

      Have you ever considered no insulting people you don’t know? (FWIW: I’m one of the ones who was here two years ago, advocating primarying him.)

      You’re still not worth the effort. Go whine about ‘Obots’ somewhere else, like FDL.

  13. Ben Franklin says:

    “At a Thursday press conference, CDC director Dr. Tom Frieden avoided claiming that this strain of Ebola is not airborne. Rebecca Hamman of Voice of Nigeria asked: “You just said the transmission of Ebola is through close contact. But it seems it’s going beyond that. The name itself was derived from a river. Do you mean the not water-borne or airborne?” She stated simply: “My people are scared at the rate at which it is being transmitted and moving very fast. I would like to know how Ebola is contracted.”

    http://www.psmag.com/navigation/health-and-behavior/scariest-virus-ebola-back-worse-ever-87348/

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