Where We’re Going Wrong With Ebola

October 16, 2014

Lady Masked DoctorFirst, Ebola would never come here. Then, it was going to be strictly contained. What Ebola will “never” do is a moving target—what are we doing wrong, and how do we contain it?

The biggest thing: we are not taking it seriously enough, and the CDC is working hard on downplaying how bad this is, when they should be working on getting out accurate information that will help people with prevention and early treatment.

First, Evidence Says Ebola Is Airborne

CIDRAP (The Center for Infectious Disease Research And Policy) is an organisation I generally think of as a moderate voice in infectious disease—they may have an opinion that dissents (like flu vaccines aren’t very useful) but they always moderate it with telling people to stick to the status quo—whatever FDA/CDC/AMA says to do.

Well here’s their latest headline: they’re pretty sure Ebola is airborne, based on the evidence, and based on having better tools available than the last time someone looked (they can see smaller particles).

Now, they aren’t saying it will be like the usual flu—highly contagious through the air—more like China’s bird flu: contagious via air in close quarters. That means family members and healthcare workers are at an even higher risk than we previously thought, and will need full face protection, not just surgical masks.

And With Each Infection, Ebola Learns And Mutates

National Geographic tends to be more about pictures than good articles these days—but they’ve got great Ebola coverage. They’ve got a good look at how Ebola is (very slowly) mutating, and a reminder about the consequences of not getting Ebola contained—all across the world—ASAP.

People Are Forgetting: We’re All At Risk

Ebola has gotten to where it is because it took months for the first world—and America in particular—to care.

It’s always been a disease that affected poor, far away people who are “different” than us. This outbreak started in December 2013, but wasn’t identified until March. And then it wasn’t until June/July, when white, American doctors got sick that we really sat up and noticed, and really started to take action.

And all of those people talking about how it won’t spread here are still making that same mistake—we are all human, equally at risk of infection, and if it affects our weakest, it can eventually reach our strongest (look at TB in Florida, and what it’s starting to do in California).

The average American has a horrible health care plan. Visiting the ER, if it’s covered at all, will still cost thousands of dollars for many people—and there’s a good chance you’ll be sent home after being given a couple of $50 ibuProfen tablets, just like the Liberian Ebola patient initially was.

And that doesn’t even touch on missing work—the jobs that will fire you for missing a day, that don’t pay enough for you to afford to—those are the people serving and cooking your food (“Ebola burgers” have become a dark humour point of discussion), cleaning your house, and doing a hundred other tasks that might barely touch your life, but touch it, all the same.

When was the last time you went to the doctor for a fever? Or for food poisoning? Did you ever take something to treat a fever, suppress a stomach ache? Hiding symptoms doesn’t make them not contagious—a much bigger problem with Ebola than other diseases.

There’s a million holes in our much-lauded system. Without immediate care, the average Ebola patient infects 2 more.

Again, We’re Really Down-Playing It Too Much

21 Days—it’s all over the news. The end of this week is the end of the initial Ebola incubation period for people in Dallas who may have come into contact with Mr. Duncan (the Liberian patient).

Or is it?

For as many as 3% of people exposed, Ebola may actually incubate for twice that—42 days. They think it’s one of the reasons we’re having trouble in Africa—we go by the 21 day incubation period, but then it pops back up!

Right now, we’ve got 100-200 people in Dallas who may have come into contact with the original Ebola patient, Mr. Duncan.

We’ve got ER patients who were exposed to him—2 visits worth. As well as all the receptionists, janitors, nurses, and doctors who were exposed before he was diagnosed. So another 100 people?

And then there are those who were exposed to the 2 nurses who caught it from him—even through protective gear (because it was airborne? Because we’re scrambling and protocols are at best inconsistent, and at worst a joke?). The first nurse got into isolation right away. The second nurse got on a plane to visit family, and had a slight fever on the way home. That’s another 100 people (the airplane passengers and her family) who are under watch.

That’s 300-400 people, or 9-12 who could “surprisingly” have Ebola in 42 days, not 21.

And Our Hospitals Aren’t That Prepared

Some are, some aren’t. Nurses are coming out all over the place to say they feel scared and unprepared. Some hospitals are doing drills—with different levels of success, since people aren’t sure and are unpracticed, and protocols are changing constantly right now. Some hospitals are showing a powerpoint and calling it good. Most don’t have protective gear onsite—it was wasteful (they expire sitting on shelves) and unnecessary.

There are different accounts of how things went down in Dallas—the CDC, hospital, staff giving direct care, and the rest of the staff all have slightly different stories—like one which says nurses had to demand the protective gear, which is why they didn’t have it the first three days. Hopefully the truth comes out soon, so we can learn from it and prepare.

Even diseases less scary than Ebola have a high transfer rate in hospitals, so it’s not a new or unexpected problem.

What do you think about Ebola? No big deal, or time to pull the kids from school and avoid public transportation?

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