Bringing the two Americans back home with Ebola: Is it worth it?

Ebola is a hemorrhagic fever that causes death by what seems like a virally induced stigmata. That statement could be even shorter. With a fatality rate that can reach 80 to 90% we could just say that Ebola is death.

The World Health Organization (WHO) says this most recent outbreak is “moving faster than our efforts to control it” and the CDC is calling this “The biggest and most complex Ebola outbreak in history.” The CDC has issued a level 3 travel warning for Guinea, Sierra Leona, and Liberia.

Though highly contagious Ebola isn’t infectious until someone actually falls ill. Ebola isn’t transmitted like the flu, it requires direct contact with bodily fluids. This is good, in the sense that people aren’t walking around for 5 to 6 days feeling fine but unknowingly leaving Ebola on every surface.

However, you can feel fine and then 12 hours later feel unwell. What if in those 12 hours you boarded an airplane, quickly became ill and then vomited in the  bathroom and perhaps on one or two flight attendants? Or perhaps you felt slightly feverish on the plane and the next day you became ill, had diarrhea at home and then while you were at the hospital a family member cleaned up the mess in the bathroom without protective gear?

The WHO, the CDC, and many aid organizations have mobilized health care professionals and infectious disease experts to help on the ground in Africa, but there are many reasons why containment is proving to be challenge. Overwhelmed local resources, stigma of Ebola preventing people from coming in when they first fall ill and so quarantines fail to happen, and because the first signs of Ebola can be like any other viral illness and so is easily dismissed.

When news that two American aid workers contracted Ebola, some have some questioned bringing them to the United States. Aren’t we risking the lives of American health care workers never mind the risk of the disease escaping resulting in some kind of viral apocalyptic devastation like The Passage? (There are also apparently conspiracy theorists who think bringing Ebola here via these patients is a government plot of some kind, never mind that there are likely a few vials of it in level 4 containment labs around the world.)

The risk to the general population or anyone getting medical care or working in other units at Emory is as very low. The special infectious diseases unit that will be used was built just for this kind of thing. The people trained to work there are exactly that, trained to work there.

Compassionate reasons to bring citizens home for treatment aside, there is much to learned about treated Ebola and where better to gather that information than in a high-tech medical unit affiliated with the CDC? If we can learn how to more optimally treat patients with Ebola and better test a new serum (the two patients treated in Atlanta received a highly experimental antibody therapy, only tested on a few monkeys but when you have a disease with a very high case fatality rate and your condition is deteriorating the previous testing probably doesn’t matter too much), then we will be better prepared not only to help in Africa, but for that time when Ebola comes off an airplane.

An elderly woman collapsed in Gatwick Airport shortly after arriving from Gambia and died at the hospital. While she tested negative for Ebola the scenario that a person could get on a plane feeling okay and get off several  hours later very ill is clearly not far-fetched. She didn’t have Ebola, but she could have. A man who traveled from West Africa was admitted to Mount Sinai with symptoms that could be Ebola (could also be a lot of other things) and it currently being tested. Given the number of people now infected in West Africa and the number of people who travel internationally it is only a matter of time before it gets here.

It is true that the cost of the care given to the two Americans with Ebola is astronomically high. I have no idea how to calculate the cost of airlifting someone from West Africa in a Gulfstream jet specially equipped for such a scenario never mind the cost of the care at Emory. However, I consider it money well spent. The cost of doing nothing is astronomical. First hand knowledge of what to do (and perhaps the added bonus of a faster track to a therapy if the antibody  proves effective) will help us be better prepared when (because it is unlikely to be if) Ebola arrives on its own the United States.

The cost of bringing the two Americans with Ebola back to the United States for treatment is inconsequential compared with the cost of not doing anything.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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  • QQQ

    Dr. Michael Savage Ph.D on Ebola Virus Scare and Idiocy of Letting Infected Come into US – 8/5/14

    https://www.youtube.com/watch?v=_3IyoouAjDo

    • Eric Strong

      Savage’s Ph.D. is apparently on “nutritional ethnobotany”, and doesn’t appear to have even done any professional work in that field many years, if ever. (i.e. he is profoundly unqualified to offer an informed opinion on this issue.)

      • QQQ

        Everything you mention in your post on Ebola is also mention as well with him on his previous radio shows! If you have a chance, you can go on Youtube to listen to them He also been doing medical work in is field in nutrition for many years even to this day and publishing many books and articles about nutrition.

  • Eric Strong

    Perhaps this seems like a petty gripe with the above post, but I am tired of hearing this ubiquitously claimed mortality rate of 90% in every media description of the current outbreak and discussion of the risk of it spreading beyond Africa. The treatment for Ebola is supportive care (i.e. fluids, transfusions, vasopressors, treatment of complicating infections, etc…). There is no chance that a hospital in Sub-Saharan Africa, which is in the midst of a horrific epidemic, overflowing with dying patients and understaffed with frightened health care workers, is going to be able to provide supportive care that remotely approaches what would be done in the US or Europe. But that doesn’t stop ill-informed Americans from believing that Ebola in the US would wipe out 90% of those infected. In reality, it is highly probably that the death rate of Ebola patients treated in the US would be much much lower than this – still significant – but much lower. Quoting the 90% mortality rate is dangerous hyperbole that feeds into the public’s complete inability to approach this complicated issue rationally.

  • Tim Mosher

    Dr. Gunter,
    Your comments here are very appreciated. I was involved in the care of the two American missionaries while they were in Liberia, and their treatment with the “serum”. My hope is that this incident will promulgate the rapid development of treatment. Without this situation, it is possible that the development would have stayed locked in the analysis/paralysis mode of research. You are right, the cost of doing nothing is astronomical.

    As for the cost, Samaritan’s Purse, the NGO employer of the victim, is responsible for the airlift home. They have done this on other occasions, so it is not new or novel. Certainly, McDonald’s would fly one of its American executives home from China if they became very ill there. I am amazed and proud to have been part of such a historical event that will hopefully change our fight against this deadly demon.