We recently had our first case (other than those that came here for treatment after exposure and immediately went to secured health care facilities) of Ebola show up in Dallas. A man from Liberia got on a plane, went to Dallas, went to the ER, told them he thought he had been exposed to Ebola while in Liberia, was reassured that was ridiculous and sent home with a prescription for antibiotics. Several days later he was admitted for (drumroll please) Ebola and is being treated in the ICU. How many people did he contaminate in the time between going to the ER and returning later? If he was like me, everyone is safe except for 3 cats that like to steal food while it is being eaten. Unfortunately, he did not live alone in isolation, and there are already people being tracked for signs of illness.
I get why the places in West Africa are having a hard time with this. Poverty and war and corruption and superstition are easy to connect to poor public health control of the spread of a virus. But are we going to die in the USA of our own arrogance? For all our fancy equipment and highly trained infection control personnel, it all boils down to whether or not the possibility of the disease is recognized.
"when you hear hoofbeats, think horses not zebras" is to med school what "doing the same thing over and over expecting different results is the definition of crazy" is to Narcotics Anonymous.
Ebola in Texas is definitely a Zebra, and they treated a horse.
But the world is big, the numbers are big, international travel is common, We have all now heard of Dr.'s without Borders, but does anyone really think there are any disease causing agents that recognize borders?
While horses are the most common, if there are a couple of million people in a city, there will be any number of zebras found. If there are only 1 in a million cases of something, you should not be deny that one will appear, you should be expecting a least a couple. The chances of getting most illnesses is much better than winning our lottery, but we have lottery winners. So why aren't we expecting the diseases with lower numbers? Why wasn't the ER in Texas prepared? Why aren't we doing more to screen people traveling out of the countries with this Ebola outbreak before they get on a plane? Or off a plane?
Flu vaccines start this month. Doctors will be screening patient's in the ER for the Flu if they say they have been exposed or have any flu-like symptoms. Most of them won't have it. But Influenza is a horse we all expect. Get you flu shot if that is what you do,wash your hands, avoid touching vomit, sputum, saliva, blood, feces, open wounds, tears, exposed organs; don't hug strangers with red eyes or body-fluid covered clothing, and if someone says they think they were exposed to ebola, don't kiss them.
Use some sense, cover your cough, wash your hands, clean up after yourself or your kids, and consider some nice homebody hobbies.
Perhaps all the creepy, end-of-the-world tv shows are just making us a little paranoid---or maybe they aren't.
Key facts from WHO
- Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
- The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
- The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
- The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa has involved major urban as well as rural areas.
- Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
- Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
- There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.
Transmission It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.
Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.
Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.
People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.
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