Ebola in the United States: A reason not to panic

If an ill patient, who unexpectedly has Ebola, landed in Memphis, it is likely that my partner or I would see him. We work as infectious disease doctors at the hospital closest to the airport.

The Ebola patient would present with fever, nausea and vomiting, indistinguishable from a flu or a viral illness that hundreds of patients present with each day at our hospitals. But over a few days of the illness, the Ebola virus would take a devastating toll on my patient’s body.

Rather than being destroyed by his immune cells, the Ebola virus would cause my patient’s immune cells, namely the white blood cells, to undergo self destruction. This would lead to leakage of inflammatory mediators into the blood stream causing bleeding, and the most feared and fatal complication of Ebola, hemorrhagic fever. Over a course of a week my patient would develop bruising, a rash and uncontrolled bleeding from the ear, nose and rectum.

Ultimately, what distinguishes Ebola from all other viruses is its fatality rate; that is 75 of every 100 patients with Ebola in Guinea have died within 3 weeks. Compare this with the flu where 15 in 100,000 infected died within a few months; or even HIV, where before the “cocktail medications” became available, death occurred over 10 years.

So all in all, there is a legitimate reason to fear Ebola and its complications. Yet, there is an equally strong reason not to be panicked: It is within our ability to contain the virus.

The short term solution to the Ebola epidemic and most epidemics is not a new medicine or vaccine or an advanced technological treatment; rather it is basic and meticulous infection control practices. This means washing hands, wearing proper gear, isolation and quarantining infected or potentially infected individuals, limiting travel of individuals in infected areas and being vigilant with surveillance in uninfected areas.

Ebola thrives in West Africa because the basic health and sanitary conditions like running water or gloves are often lacking in homes and hospitals. This allows the Ebola virus, which is only transmissible by body fluid contact of blood, urine and stools — not transmissible by air — to spread from person to person.

As much as we would like to think that we are isolated and immune from the diseases in far away countries in Africa or Asia, we are not. Just as global warming pollutants and economic upturns and downturns that occur in China or India impact America and Memphis, likewise, a virus can impact us on the banks of the Mississippi, where Memphis is the second largest cargo hub in the world.

The question I often get asked is, “Where does the Ebola virus come from?” The Ebola outbreaks occurs intermittently because bats or primates carry a reservoir of the virus; when a human comes into contact with the animal meat or with an infected animal, he contracts the disease and then passes it on to others at home or among health workers, including doctors and nurses who do not use proper infection control.

So I asked Yvonne Madlock, director of the Shelby County Health Department, “What if a patient with Ebola virus landed in Memphis — are we prepared?”

She was optimistic about our preparedness effort, yet cautioned: “This is a wake up call for hospitals and providers to make sure they are following all the precautions recommended by CDC.”

The bigger question I have is, is the general population in Memphis prepared for a potential patient?

As for many health professionals and me, the thought of a patient landing in Memphis and us having to treat him does not keep us up at night. Rather, the knowledge we have of the disease and how it spreads, and the support we have from the health department and Centers for Disease Control and Prevention, is empowering.

Oftentimes people do not realize that our fear overwhelms us because ignorance overtakes us. Often, others — maybe the media — play on our fears to get our attention about a disease, but do not do a good enough job to educate and empower us.

Manoj Jain is an infectious disease physician and contributor to the Washington Post and The Commercial Appeal.  He can be reached at his self-titled site, Dr. Manoj Jain. This article originally appeared in The Commercial Appeal.

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