Global Doc: Going Viral

Author: Dr. Vincent DeGennaro Jr. ’02

Vincent DeGennaro

There’s a virus spreading in the United States. It’s desperately contagious and potentially lethal, even to those who are not infected by it. The virus spreads through geometric progression, each infected person affects dozens of people around them. The virus stalks the hallways of schools, runs rampant in airports and corrodes those who walk the halls of power. Scientists have quantified and studied the virus for ages, watching it creep into large populations, causing untold destruction.

Ebola is not the virus to fear. Fear and panic are spreading faster than any organic living matter possibly could.

To combat the epidemic, we are forced between two choices. We can stop shaking hands, avoid air travel altogether and keep our children home from schools that are a thousand miles from even one virus particle of Ebola. We can sit glued to the television watching ambulances travel while being filmed from news choppers high above. We can allow public discourse and politics on the subject to devolve to the level of middle school finger pointing.

Or we can listen to what the experts at the CDC say — remembering that they were the ones who eradicated smallpox, discovered how HIV was transmitted and are responsible for tracing and identifying epidemics of food-borne illness every day. We can have an honest discussion about what effect the cutbacks in government spending at the NIH and CDC have had on their ability to respond to threats to our health. Not only are there fewer personnel on the ground to combat epidemics, but the slashes in research budgets have decreased studies on neglected tropical diseases like Ebola — and on more common illnesses in the U.S. such as Alzheimer’s.

Ebola is not spreading in the United States and common sense approaches must prevail. Two unfortunate nurses who lacked the proper equipment and training to interact with an infected patient acquired the disease in a clinical setting, paralleling the situation in West Africa. But the U.S. has indoor plumbing, meaning family members won’t be forced to empty buckets of Ebola-infected diarrhea or vomit. Placing patients in isolation wards and properly equipping the staff with gloves, gowns, masks and eyewear will further limit the transmission. Transmission won’t be zero, but the epidemic will be easily contained and we must reject false images of an American post-apocalyptic wasteland where only Will Smith can save us from the legions of zombie vampires that have replaced humanity.

Common sense and proactive, instead of reactive, planning for public health will combat the epidemic of panic. Politicians and pundits, who have never traveled to a developing country, are the ones calling for travel bans. Similarly closed-minded persons attempted to keep HIV out of the country in the past, and then those same voices failed to invest in public health infrastructure to prevent the spread inside the country, resulting in an unchanging rate of new infections at 50,000 annually.

Images of poor Africans bleeding to death, with blood streaming out of eyes and ears as they expire, infects the sight of those who have the panic virus. In fact, only 18 percent of patients with Ebola in this epidemic have any signs of hemorrhaging and the official name of that disease was changed from Ebola hemorrhagic fever to Ebola virus disease to reflect this fact.

Of the 17 people who have been treated for Ebola in a developed country with a functional healthcare system, only four have died. That’s a mortality rate of less than 25 percent, significantly less than the 70 percent reported in West Africa. Furthermore, those four were all infected in West Africa and were already significantly ill when they started receiving care in a developed country, including the unfortunate Liberian man in Texas who stayed at home for a week with no medical care. What would the mortality rate be if they had received aggressive fluid resuscitation and blood products right from the start? Experts in infectious disease estimate that the mortality rate would be only 10-20 percent if patients were treated promptly and aggressively via modern healthcare systems.

So let’s all breathe a sigh of relief knowing that we’ll likely be fine if Ebola comes to our neighborhood. The panic should not be for yourself and your family, but the predictions for West Africa are staggering. Prediction models from the CDC estimate that as many as 1.4 million cases of Ebola could occur in West Africa by January. With a mortality rate of 70 percent, that’s nearly one million deaths in six months.

However, if we can deliver proper healthcare and we assume a 20 percent mortality rate, then the number of deaths could decrease to 200,000. More treatment centers result in fewer patients cared for and buried by their loved ones at home, preventing further transmission of the disease. Treatment, then, is actually prevention.

The concept that treatment of infectious diseases prevents further spread has been demonstrated repeatedly throughout history, from multi-drug resistant tuberculosis epidemics in New York City to HIV in Africa to cholera in Haiti. What could be a million deaths shrinks to tens of thousands. Horrific nonetheless, but much less so if we take active, aggressive measures to combat the Ebola virus where it started instead of embracing the useless panic at home.

If you’re worried about dying, lose weight and quit smoking. Take the medicines for your blood pressure that your doctor prescribed. Wear a seatbelt and a condom (hopefully not at the same time). Once you feel safe in suburbia again, turn your thoughts outward. Donate time or money to organizations that are helping to treat and contain the Ebola epidemic. Support political candidates that seek to strengthen public health infrastructure, both at home and abroad. Help developing countries build their healthcare systems through sustained and targeted foreign aid. Inoculate yourself and your family from the panic by informing yourself from reliable news sources, most of which must be read and not viewed on cable television. Instead of closing our borders and hiding in a bunker, let’s all open our hearts and minds to do more for our brothers and sisters in need.