Ebola Perspective, please …

October 7, 2014

rodneyrohde112108The following is a guest post provided by Dr. Rodney E. Rohde, Chair & Professor, Clinical Laboratory Science (CLS), Associate Dean for Research, College of Health Professions at Texas State University.

I tend to get asked daily about the concern I have regarding the recent Ebola case that showed up in Dallas, TX which is about three hours from my home. I usually count to ten silently, and then try to educate my friends, family, colleagues, and others who know my professional credentials (Specialist in Microbiology and Specialist in Virology via ASCP certification) and my career as a public and clinical microbiologist for over two decades.

Yes, Ebola is a killer. Yes, it’s a very scary type of death with hemorrhaging and multi-organ failure. Yes, it’s true. More travelers could arrive in the US from those regions in the world where Ebola has been endemic for decades. Yes, we should be concerned about travel from those regions. Yes, we should review how we take travel and patient histories from individuals coming to emergency departments, to our primary care clinics, and other healthcare facilities with typical Ebola symptoms. YES, we should as a nation be vigilant in our handling of exposure contacts and ensure that our public health standard operating procedures are current and decisive in how we enact those plans.

NOW….everyone, relax and let me try to give you some perspective. Take a step out of the media news blitz and breathe. Ebola is primarily a “caregiver’s disease” that typically only is transmitted by those who handle patients and those who have died from Ebola, specifically their body fluids (blood, etc.). It is NOT transmitted via airborne routes. Those of us in epidemiology and public health talk about a pathogen’s Ro (basic reproduction number/rate/ratio) which can be thought of as the number of cases one case generates on average over the course of its infectious period, in an otherwise uninfected population. Generally, the larger the value of Ro, the harder it is to control the epidemic. For some typical, well know diseases and their Ro values, see the list below.

Measles, Airborne, Ro = 12-18
Pertussis, Airborne droplet, Ro = 12-17
Diphtheria, Saliva, Ro = 6-7
Smallpox, Airborne droplet, Ro = 5-7
Polio, Fecal-oral route, Ro = 5-7
HIV, STD, Ro = 2-5
Ebola, Bodily fluids, Ro = 1-4

The basic reproductive rate is affected by several factors including the duration of infectivity of affected patients, the infectiousness of the organism, and the number of susceptible people in the population that the affected patients are in contact with. When we truly examine Ebola with an unbiased eye, experts agree that Ebola is not a threat to start a rampaging epidemic in the US. Indeed, its Ro is one of the lowest when it comes to scary diseases.

Certainly, we see that outbreaks can happen in areas where standard healthcare precautions (personal protective equipment, quarantine measures, barrier nursing, aseptic technique, burial techniques, etc.) are not being followed with Ebola patients and those who die from Ebola. If we follow proper procedures and are vigilant in our efforts, everything can and should be fine. Will we have other cases in the US? Of course we will. World travel makes this possibility inevitable. We do not have an exclusive right to not have Ebola cross our borders and oceans. Microbes, not just Ebola, do not CARE about politics or how well we think our healthcare system works REGARDLESS of ones economic status or political affiliation. I always tell my clinical laboratory science students that “microbes do not read the books” and do not always follow the rules. Viruses are particularly brutal when it comes to their mutation rate and ability to adapt to the human immune system or environmental barriers.

I also would like to offer this important information for those who are becoming critical of our physicians, nurses, and public health system in general. It is almost impossible to recognize Ebola in a person who has just started undergoing symptoms. Fever of about 102F, headaches, muscle pain, and maybe some nausea. Hmmm….does this sound like influenza? How about food-borne illness? Allergies can even mimic these types of symptoms. Please keep this in mind. Those in healthcare are sometimes like policemen. They make an educated judgement based on what they see and other information (patient history) that they can gather, usually under very difficult and busy circumstances. Our healthcare system can not panic and begin to quarantine every person who shows up at an emergency room with these symptoms. So, please, unless you truly understand the difficult circumstances that these healthcare professionals face on a daily basis don’t be so quick to crucify them. They are often doing the best they can in not so great conditions. But…that’s another subject, and perhaps, another post at a later date.

And, what is also sad about the Dallas Ebola patient being “sent home with antibiotics” the first time he visited is just that – all too often any illness is treated this way. Throw a prescription at it instead of doing a proper work up with a culture and other laboratory tests to confirm an illness. This is often related to a number of difficult factors – too many patients, financial concerns, jam packed waiting rooms – that we can’t get too in depth about here.

Finally, I would like to remind everyone in the US (and in many other countries like the UK, etc.) that what you should be most concerned about is not Ebola when it comes to infectious diseases. Influenza and tuberculosis are constant killers every year in this country. New viruses like Enterovirus 68, which IS TRANSMITTED by airborne routes, is causing new concerns that it may be linked to paralysis in children. Please don’t get me started on vaccine-preventable diseases that are ignored more and more. Just look to the current resurgence of pertussis and measles in this country. Our grandparents and those before them should be ashamed of us. They know how deadly these agents are and can be again!

Lastly, please, consider this exploding and growing US and global epidemic that is occurring right now. Did you know that Healthcare Associated Infections (HAIs), such asMRSA, Clostridium difficile, VRE, CRE, etc.) are responsible for about 279 deaths in the United States EVERY DAY?

Folks, if you want to talk about perspective regarding Ebola, try this on for size.

HAIs kill over 100,000 people every year in this country.

Most of these infections occur in the healthcare setting or in the community (like jails, athletic centers, college dorms, and other common environments). Yes, I said every year in the United States. Consider a jet airliner crashing every day in this country with your loved ones aboard. Now, THAT IS SOMETHING to get upset over. HAIs are just one of many public health threats we should all be upset over.

Let’s all try to keep our perspective and find ways to work cooperatively and constructively across this country and with others around the globe to strengthen our public health system and support our healthcare professionals. These are usually hidden professionals who are all too often taken for granted until it’s easy to criticize an “event” like the recent Ebola cases in the US. Perhaps, we should all keep that in perspective.

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