I don’t worry about known Ebola patients coming to the US under controlled conditions. I worry about unknown incubators traveling here and then becoming ill among the general population. It’s already happened.
So the news came this week that a man flew from Ebola-stricken Liberia to visit relatives in Dallas, TX, and now he is the first case diagnosed outside of Africa. Congrats, America! We have our first case to erupt on US soil.
The Dallas Ebola case was inevitable, given the size of the epidemic raging in West Africa and the ease of modern air travel, infectious diseases specialists say. Indeed, many told MedPage Today, the longer the African epidemic lasts the more likely such cases become, not only in the U.S,. but in other developed countries.
Not to worry, though. Mr. Smith continues:
But the risk to the general public in the U.S. and the likelihood of a wide outbreak are vanishingly small, the experts agreed.
Mr. Smith and others have reassured us that US facilities are far better equipped to deal with a disease like Ebola than are the facilities in Liberia, and that much is true… yes, we are better equipped than an impoverished and overwhelmed health system. But are we adequately equipped against a disease like Ebola, which gets the CDC’s Category A rating… the same rating as smallpox, plague, and anthrax… due to the high mortality rate?
I can understand that no one wants a panic, but the reassurances of public officials need a healthy dose of caution and precaution. “It’s not likely here” has already become “We have our first case, which was inevitable,” and “IF it ever happens here, we’re ready” has already become “Oops.”
Consider how this case was handled. My first gripe is that we are still allowing people to travel here from Ebola-infected areas despite a typical incubation period of about 8-10 days… meaning that an infected person could unknowingly bring the virus into the US, which is exactly what happened in Dallas. The man arrived on 20 September apparently feeling fine, and did not go to the hospital until the 26th.
My second gripe is that despite all the medical community’s claims of vigilance and readiness, the triage nurse’s report that the man had been in Liberia — critical information!! — did not reach the treating physicians. So this patient was initially diagnosed with a “common virus,” then discharged from the hospital and went home, where he spent two more days in the company of his family. He was not isolated until the 28th. As the CDC tells us in its fact sheet,
The viruses that cause Ebola HF are often spread through families and friends because they come in close contact with infectious secretions when caring for ill persons. During outbreaks of Ebola HF, the disease can spread quickly within health care settings (such as a clinic or hospital). Exposure to ebola viruses can occur in health care settings where hospital staff are not wearing appropriate protective equipment, such as masks, gowns, and gloves.
Well… um. I’m no doctor, but it seems like his family members are now at risk. And if they are at risk, who else is at risk?
My third gripe is that we are assured that Ebola is not all that easy to catch, and the general public is not at risk. Okay, it’s not an airborne virus, but still. Ebola symptoms are maddeningly like a lot of other things: abdominal pain, rash, vomiting, fever, and here we are heading into flu season. So if some kid has a stomachache and throws up at school, does the janitor or the school nurse have any reason to think it’s Ebola? It’s probably not… no, it’s almost certainly not. But this is how Dr. Rick Sacra was infected: he was working in maternity wards in Liberia, not in Ebola clinics, and yet he still got the disease, probably from an unrecognized case of Ebola among his maternity patients. Our very own patient in Dallas was also an unrecognized case for a few days, wasn’t he? Who else is out there? Are we planning to test every US soldier returning from Liberia?
Okay, what about protective gear? I’m betting that Dr. Sacra wore gloves and protective clothing in the maternity ward. I’m betting that our hypothetical school nurse or school janitor would wear gloves while dealing with a sick kid’s mess. I’m also worried that might not be enough. Health-care workers and burial teams in Liberia are wearing gloves, gowns, and face shields, after all… they know what they are dealing with, and take precautions… and some of them are still managing to get infected.
This outbreak numbers in the thousands already, the largest ever recorded. The CDC predicts that by January, there could be a high-end estimate of as many as 1.4 million cases in Liberia and Sierra Leone. Even if we’d like to discount that number as a worst-case scenario, these words from the CDC should give you a chill:
Cases in Liberia are currently doubling every 15-20 days, and those in Sierra Leone and Guinea are doubling every 30-40 days.
It’s scary as hell.