Tuesday, August 5, 2014

Ebola: Should We Be Worried?

I've talked to a lot of people who are worried about the fact that the US has already flown one ebola patient back from Africa - with a second en route.

Ebola, full name "Ebola hemorrhagic fever," is a rather nasty zoonotic disease that flares up occasionally in tropical parts of sub Saharan Africa, often as a result of people eating bush meat - specifically dead primates (This is also how AIDS got into the human population...but the people in these countries are very poor and this is often the only way they can get meat).

And yes, it's a scary virus. There is no vaccine (yet). There is no specific treatment. Fatality rates range, depending on which of the five species of Ebola is involved, from 50 to 90 percent. And some of those infected bleed from every orifice.


Should we be worried? And why would the United States risk flying people with this horrible disease back to the country?

Okay. Here are some facts.

Ebola is nasty. It is likely to kill you. It is also not that contagious. In order to catch ebola, you have to come into contact with the bodily fluids of somebody who has ebola (or eat a monkey or pig that was infected with it). Unlike influenza or some of the other respiratory viruses that have caused scares lately, ebola is not an airborne virus. (It can, however, survive on surfaces for a couple of days).

So, the only people at real risk of ebola are family members...and healthcare workers. Both of the two infected Americans being returned to the United States are doctors. Another top expert on ebola who went to deal with the outbreak died of the disease.

You won't catch ebola from, for example, being on the same plane as somebody who has it. Or in the same building.

Next question, though, why take the risk?

The reason this ebola outbreak is so bad is because it hit particularly poor parts of Africa with a lousy medical infrastructure. So, it might simply make sense to bring these people somewhere with better medical care, but there's more to it.

There's no treatment for ebola...yet. An experimental serum has been developed and tested on monkeys. Until now it has not been tested on humans...and the patient brought back to the US last week was the first human "guinea pig."

The treatment is not approved - so it would have been given under what the FDA calls a "compassionate use" exemption. This means an unapproved treatment being given to a patient they know is very likely to die anyway. I've seen it asked why they're testing it on Americans - the answer is because if they tested it on a non-US citizen and they died, it could cause diplomatic problems.

And obviously, you don't want to be messing around with experimental treatments in an area where the medical infrastructure is particularly crappy.

The tl;dr:

1. We are highly unlikely to have an ebola outbreak in the United States. The disease is not that contagious and modern hygiene can control it to an extent.

2. The patients being brought back are being brought here for some very good reasons, under full quarantine precautions.

And the good news? The patient given the serum appears to be improving...