America’s worst microbial nightmare stepped through the looking glass and into our lives this September when a patient arrived at a Texas hospital harboring the first U.S. case of Ebola. In the months preceding this index case, news organizations had tracked the West African death toll of this unforgiving virus. A plane carrying an infected American missionary to Atlanta this summer put the nation on high alert. Now that the Ebola patient in Texas has died, the obvious question had to be asked: could an Ebola outbreak happen here?
Surprisingly, this is not the first time the Centers for Disease Control and Prevention has had to contain a deadly virus imported from overseas. In the last decade, rare cases of infections from Ebola’s dirty cousins (collectively known as hemorrhagic fever viruses) have washed up on our shores. What makes those pathogens different, however, is that they slipped into the country outside of the white-hot glare of international attention. Richard Preston’s 1994 bestseller, The Hot Zone, chronicled the earliest Ebola outbreak. Now twenty years later, public health officials are asking what might happen if Ebola spreads in the United States.
In my own corner of the medical world, I spend large portions of my day interacting with patients and their viruses. For most of those who bring viruses in to see me, over-the-counter medications and a dose of reassurance are prescriptions for improvement. But Ebola is no ordinary virus. And these are no ordinary times.
Imagine being one of the staff members who first interacted with the infected Texas patient. Two days before he was diagnosed, he visited a local emergency department with non-specific symptoms. Like thousands of patients before him, he was sent home with the diagnosis of a viral infection. Unknown to everyone at the time, though, he had a rapidly replicating Ebola virus ticking in his blood stream like a biologic bomb. Everyone who interacted with him—from the staff who checked him in to the nurse who checked his vital signs—is probably fearful for their own health. If one of the exposed patients came to my office, what help, besides words of comfort, could I possible give him? As it turns out, public health officials already have advice for those exposed but not infected:
- Don’t Panic: Exposure to a person with Ebola is perhaps the second greatest fear for the general population. The father of all fears, however, has to be the concern of actually contracting Ebola. Know that the chance of getting Ebola in the U.S. is remote. Solid medical evidence confirms that in order to contract Ebola, a person must directly interact with body fluids from an infected patient. Most of the infections in West Africa have spread through direct contact with these body fluids, either while tending to ill patients or treating the bodies of Ebola victims. Casual contact in an airplane cabin or sharing a space in a waiting room is not a risk factor. For clinical personnel, the universal precautions already employed offer an effective first line of defense.
- Stay Home: Even though exposure does not sentence one to illness, casual contact with an Ebola patient may have swept someone up in an infectious disease dragnet. In this setting, a period of quarantine at home is the safest course of action. If after three weeks of observation a person remains symptom-free, no more testing is needed.
- Wash your hands: Universal precautions are the rule for medical providers while interacting with body fluids. To stop rogue pathogens, hand hygiene takes a more prominent role. Patients and providers should get back to the basics of cleaning their hands with soap and water. Antiseptic alcohol wipes and sanitizing gels are effective at killing viruses. However, certain types of germs, such as the spore-forming bacteria C diff, can shrug off the effects of sanitizers. Thorough hand washing with soap and water – including a fingernail scrub – will effectively reduce the spread of all pathogens.
- Listen to your body: Infection with the Ebola virus is not a subtle condition. We know that asymptomatic patients do not spread the disease. Once an Ebola infection awakens, it shows up with a starburst of symptoms, from headaches and fevers to vomiting and diarrhea. Some patients experience spontaneous bleeding. Your body is talking to you, but are you listening?
- Ask for help: If the symptoms begin, get help immediately. Tell your story, including suspected exposures and recent travel history. An entire public health system is primed and ready to respond. Patients who have recovered from Ebola infections did so with the help of supportive care. Experimental drugs are not ready for prime time. Refuge with approved vaccines is years away. However, if caught early enough, a patient with an Ebola infection can benefits from IV fluids and close monitoring in an isolated medical ward.
Panic and fear are natural responses to a deadly disease, but the facts of medical science offer a beacon of hope to patients in need. Know that Ebola is hard to catch. Know also that there is hope for those exposed.
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