Thursday, October 16, 2014

Ebola and the Sum of All Fears

It’s the single greatest fear I’ve had in my forty year public health career. I can’t imagine anything – and that includes HIV – that would be more devastating to the world than respiratory transmission of Ebola virus. This is the sum of all fears.

Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota

I have been asked by one of my blog readers, now approaching 10,000 each day, to comment on Ebola fears, on whether this festering viral epidemic will engulf the world.

This request reminds me to two things.

One is President Franklin Delano Roosevelt’s comment after Pearl Harbor, “ The only thing we have to fear is fear itself.”

Two is my nurse wife’s comment, “Dick, they say Ebola is only spread through contact with body fluids. What happens when people cough viral droplets. Those are body fluids.”

My wife has a point. Sputum and respiratory droplets are body fluids. What would happen if unsuspected infected Ebola victims coughed or even breathed aboard trains, plans, or in public places, or in crowds of people, spewing viral-laden respiratory body fluids.

We have more to fear than fear itself . We have respiratory-spread body fluids to fear. We have ignorance of how this deadly virus is transmitted, killing 70 % of its victims.

Here are a few comments by Michael Osterholm on the problem in a New York Times artricle. “What We’re Afraid to Say About Ebola," September 12, 2014).

Osterholm's comments were made before Dallas, Ebola's spread to Spain, the Ebola panic in Washington, D.C., the flight of an infected nurse from Dallas to Cleveland, the closure of schools in Dallas and Cleveland, the political finger pointing at the Obama administration, and demands for a travel ban from West African nations of Liberia, Sierra Leone, Guinea, and Nigeria and for the ouster of the Head of the CDC.

I believe three serious mistakes have been made by the Obama administration: 1) not instituting a travel ban from afflicted African nations; 2) not forbidding an infected nurse from Dallas to Cleveland even after she asked permission from the CDC to fly; 3) falsely reassuring the nation that no problem of a pandemic exists.

Otherwise, as an uninvolved bystander, I am in no position to comment.

But I do think it is worth reprinting some of Dr. Osterhholm’s comments from a September 11 New York Times article.

“THE Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done.”

“There have been more than 4,300 cases and 2,300 deaths over the past six months. Last week, the World Health Organization warned that, by early October, there may be thousands of new cases per week in Liberia, Sierra Leone, Guinea and Nigeria. What is not getting said publicly, despite briefings and discussions in the inner circles of the world’s public health agencies, is that we are in totally uncharted waters and that Mother Nature is the only force in charge of the crisis at this time.”

“There are two possible future chapters to this story that should keep us up at night."

“The first possibility is that the Ebola virus spreads from West Africa to megacities in other regions of the developing world. This outbreak is very different from the 19 that have occurred in Africa over the past 40 years. It is much easier to control Ebola infections in isolated villages. But there has been a 300 percent increase in Africa’s population over the last four decades, much of it in large city slums. What happens when an infected person yet to become ill travels by plane to Lagos, Nairobi, Kinshasa or Mogadishu — or even Karachi, Jakarta, Mexico City or Dhaka?”

“The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.”

“If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus”

“This is about humanitarianism and self-interest. If we wait for vaccines and new drugs to arrive to end the Ebola epidemic, instead of taking major action now, we risk the disease’s reaching from West Africa to our own backyards.”

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