I thought, given the increase media coverage on Ebola, it would be good to reiterate and expand upon my previous post. The idea that the Ebola virus is the mother of all pathogens is deeply rooted in US culture and beyond. Every time some film or television series episode concerns a disastrous “outbreak” (as in the movie Outbreak), the horrific disease is compared to Ebola, the worst of the worst until e.g., “HEAT-15” (which “makes the Ebola virus look like a skin rash) or actually is Ebola (as in Clancy’s Executive Orders.
The truth is that Ebola itself isn’t all that serious:
“Notably, Ebola virus is a zoonotic pathogen, and its circulation among humans is uncommon, which explains the intermittent and unpredictable nature of outbreaks. In fact, although the virus has caused more than 20 outbreaks since its identification in 1976, it had caused fewer than 1600 deaths before 2014, with case counts ranging from a handful to 425 in the Ugandan outbreak of 2000 and 2001. In most instances, the virus emerged in geographically restricted, rural regions, and outbreaks were contained through routine public health measures such as case identification, contact tracing, patient isolation, and quarantine to break the chain of virus transmission… Although the regional threat of Ebola in West Africa looms large, the chance that the virus will establish a foothold in the United States or another high-resource country remains extremely small.”1
So why has the news that two healthcare professionals have been diagnosed created a renewed panic after the already overblown news about the first confirmed diagnosis (of a passenger traveling from West Africa to Texas)? Why have so many died from this disease? Why is it an international healthcare issue that does require more attention? It’s not because of the virus:
“…the World Health Organization (WHO) now reports more than 5300 infections and 2600 deaths across Guinea, Liberia, and Sierra Leone, with broad consensus that the true burden of disease is far greater.
Yet if the Ebola virus surfaced in Boston or Toronto, there is little doubt that their health systems, despite shortcomings, could effectively contain and then eliminate the disease with far lower case-fatality rates than those reported now in West Africa. Why the disparity when there is no proven drug or vaccine available? The answer lies not with the virus, but in the collective failure to ensure the availability of adequate health care staff, resources, and systems required for the delivery of high-quality health care services. The Ebola epidemic has placed this failure into stark relief, exposing the pathology of chronic neglect amid broad global inequalities.”2
“Yet despite the vast scale of the current outbreak, the clinical manifestations of Ebola virus disease, the duration of illness, the case fatality rate, and the degree of transmissibility are similar to those in earlier epidemics. It is therefore unlikely that the particularly devastating course of this epidemic can be attributed to biologic characteristics of the virus.”3
This recent outbreak has resulted in more deaths than all previous outbreaks combined4, yet the virus, spread, and treatment is comparable to the 1976 outbreak.5. A combination of media nonsense, political BS, rampant misconceptions, and general apathy regarding the only place most commonly referred to by the name of its continent rather than by country (Africa), have all contributed to current failures to control the spread of a “readily controllable” epidemic6. However, instead of a call for more aid and more help to end the death toll (already ~3,000) of an epidemic plaguing West Africa, what do media outlets report on? The non-existent threat to the US. Three reported cases are enough to motivate people who worry about vaccinations to buy illegal, fake Ebola medicine7. Hundreds of blogs, online media outlets, news channels, etc. are pouring out stories concerning issues such as whether or not the CDC did or did not inform one of the two healthcare workers that she could travel by plane, whether the president’s reassurance is hollow, and in general how the “US Scrambles to Contain Ebola“. All because of the three confirmed diagnoses, and all at a time of a very real healthcare crisis in West Africa. We worry about planes, trains, and automobiles out of ignorance:
“Sharing airspace with an infected patient is not a risk factor. Transmission requires direct physical contact and is inefficient. Studies of household contacts of patients with Ebola are informative in this regard. Among 173 household contacts of 27 patients with confirmed Ebola, the transmission rate was only 16% despite none of the standard infection control precautions routinely employed in U.S. hospitals being used. Of the 173 householders, 78 reported no physical contact with the infected patient. None became infected. Among those who did have physical contact, the risk for Ebola was highest after contact with patients’ blood. Other investigators have reported similar findings.”8
We worry about radically unrealistic scenarios from movie plots and books based on the 2 sole cases of confirmed diagnoses of Ebola contracted in the US, while in numerous countries the death toll continues: Sierra Leone, Liberia, Nigeria, & Guinea.
1Fauci, A. S. (2014). Ebola—underscoring the global disparities in health care resources. New England Journal of Medicine.
2Page, J. P. (2014). The Ebola Outbreak, Fragile Health Systems, and Quality as a Cure. JAMA.
3Farrar, J. J., & Piot, P. (2014). The Ebola Emergency—Immediate Action, Ongoing Strategy. New England Journal of Medicine.
4Frieden, T. R., Damon, I., Bell, B. P., Kenyon, T., & Nichol, S. (2014). Ebola 2014—new challenges, new global response and responsibility. New England Journal of Medicine.
5Breman, J. G., & Johnson, K. M. (2014). Ebola Then and Now. New England Journal of Medicine.
6Dhillon, R. S., Srikrishna, D., & Sachs, J. (2014). Controlling Ebola: next steps. The Lancet.
7Kuehn, B. M. (2014). FDA Warning: Phony Ebola Treatments Being Sold Online. JAMA, 312(12), 1185-1185.
8Yokea et al. (2014). Ebola Fever: Reconciling Ebola Planning With Ebola Risk in U.S. Hospitals. Annals of Internal Medicine.