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Ebola: Should we worry?

October 16, 2014

Photo of a blue germ maskAs the deadly Ebola virus races through West Africa, its grip on the collective United States attention is reaching a fever pitch.

President Obama speaks almost daily on the outbreak, proclaiming it a “top national security priority” Oct. 6 and calling the next day for ramped-up airport screening procedures.

Journalists staged across Dallas to report any and every breaking detail on the case of the infected Liberian man who finally succumbed Oct. 8; those same reporters now are covering the story of the man’s nurse, the first person to contract Ebola in the United States.

One of their media colleagues – an NBC News cameraman who’d traveled to Africa to cover the epidemic – is infected and receiving treatment in Nebraska.

News also came last week that a nurse’s assistant in Spain is now infected with Ebola, the first person known to have contracted the virus outside of Africa during the current outbreak. She was assisting in the care of a Spanish missionary and a Spanish priest, both of whom contracted Ebola in West Africa and died after returning home.

Wednesday morning brought reports that a second health care worker in Dallas contracted the Ebola virus.

Meanwhile, U.S. lawmakers have approved $750 million to fight Ebola in Africa. Ninety military personnel arrived Oct. 9 in Liberia, raising the total number of troops to more than 300. Another 700 will deploy by month’s end.

So, is there reason for concern in this country? Yes and no, say two NIU biologists and a professor of public health.

Neil Blackstone

Neil Blackstone

“We maybe should worry,” says Neil Blackstone, a professor in the NIU Department of Biological Sciences whose field of interest is evolutionary biology.

“We don’t yet have a grasp of how it got to West Africa, and the concern is that it’s evolving. It’s evolving to be a better human parasite than it has been, perhaps less deadly but more transmittable,” Blackstone adds. “If it infects 1,000 and kills them all, that’s one thing. But if it infects 1 million people and kills 10 percent of them – 100,000 – that’s another.”

Barrie Bode, chair of the department, similarly urges caution.

“The likelihood that we could see a pandemic here is extremely remote, but vigilance is probably advisable right now. We do have a great deal more resources here and protocols that are in place. We can easily isolate the virus and prevent its spread here,” says Bode, who studies the biology of cancer.

“In these Third World countries, it’s much more difficult because they don’t have the resources,” he adds, “and viruses are notorious for mutating. Because the human-to-human transmission rate has been so high, it gives the virus more opportunity to evolve with each subsequent infection.”

Bode and Blackstone are quick to point out that neither is an expert in infectious disease or Ebola itself. They can offer scientifically literate interpretations of the emerging epidemic, however, and are following the news closely.

Sarah Geiger, assistant professor of public health in the NIU School of Nursing and Health Studies, agrees that the possibility of a widespread Ebola outbreak in the United States remains remote.

Sarah Geiger

Sarah Geiger

Geiger traces some of the anxiety to modern advances in outbreak containment. “Public Health Preparedness as a sub-field has grown substantially in terms of workforce as well as funding dollars since the events of Sept. 11,” she says, “so I think as a nation we’re more aware of the value of preparedness, which can unfortunately also lead to unreasonable fear.”

However, “I do think that parts of Africa will ultimately be devastated by the virus,” Geiger says.

“The current Ebola virus disease outbreak has already far surpassed historically noteworthy outbreaks, namely in what is now the Democratic Republic of the Congo – several hundred cases in 1976 and again in 1995 – and the 2000 Uganda outbreak’s 425 cases,” she adds. “In today’s context of 8,000 cases and counting, a healthy respect for the disease and a heightened awareness are warranted.”

Money poured into protecting the United States from Ebola is better spent in Africa, she adds.

“Although prevention and preparedness are important at home, the focus should remain on curbing the outbreak itself. Sinking inordinate amounts of resources into screening and border control here in the U.S. probably doesn’t make good sense when the same amount of dollars spent on-site would bring us all much closer to the end of the outbreak,” she says.

“Of course, the United States and other countries can’t staunch the Ebola outbreak in Africa without buy-in and participation of affected countries, but we certainly can play a key supportive role.”

Ebola first was discovered and named somewhere between 40 and 55 years ago; scientists eventually determined that fruit-eating bats were a major reservoir of the virus, found mostly in remote villages of Central Africa.

“Outbreaks occur fairly frequently in Central Africa. Probably they start when a fruit-eating bat eats part of a piece of a fruit and drops it. Then, a person comes along and eats it, ingesting part of the saliva. It makes you very sick very quickly,” Blackstone says.

Barrie Bode

Barrie Bode

Ebola currently is a blood-borne disease transmitted through direct contact of bodily fluids, including mucus membranes and secretions such as sweat. Usually found in tiny and isolated villages in Central Africa, the disease typically spreads through tiny populations of people who don’t travel far from their homes.

Although there is some debate as to whether aerosol transmission is possible – uncovered coughing or sneezing, for example – the Centers for Disease Control and the World Health Organization has no evidence to support that.

Its unexpected and prolific debut in West Africa is troublesome, however.

That part of the continent is densely populated and severely poor with Spartan living conditions, minimal health care and, in Sierra Leone, steep mortality rates including the world’s highest for children 5 and younger.

“The basic grasp of infectious disease is perhaps much more limited in these countries. The citizenry is not scientifically informed and somewhat suspicious of the government and its pronouncements,” Blackstone says.

By the same token, he is “shocked” by what happened in Dallas.

“A fellow who’s a Liberian national walks in there with a fever, and they send him home with antibiotics? That’s just absolutely crazy,” he says, adding that the consequences are many.

“The CDC is tracking all of this person’s contacts, monitoring these patients who had contact with Patient Zero for fever. Ebola is not transmissible until you’re showing symptoms,” he says. “But we’re getting into influenza season, when a lot of people have fevers for other reasons. This could become complicated.”

Centers for Disease Control logoDespite the fatality in Texas, he says, U.S. health care is strong.

“We’re in a lucky position in comparison to Sierra Leone and Liberia,” Blackstone says. “In our favor, we’ve got a good health care infrastructure, a relatively well-informed citizenry who by and large appreciate the importance of things like vaccines – in spite of what Jenny McCarthy says – and the need for isolation in cases where people have infectious disease.”

Bringing people with Ebola into the United States and providing the appropriate circumstances of care poses “virtually no risk,” he says.

Patients are taken directly to specialized care centers built specifically to house people with deadly diseases, “right down to how the HVAC system works. The air isn’t being blown out. These are very secure facilities. When they’re transporting a person they know has a disease, they’re very careful.”

For Americans, the steps to prevention are simple. If travel to West Africa is necessary, avoid close contact with strangers. Wash hands frequently with soap and water.

“The temporal placement of this Ebola outbreak in the information age is a plus,” Geiger says, “in that health care workers, hospital administrators, public health professionals and the average person can access an abundance of information on reliable protocols for safe transport, treatment, worker protections, etc.”

Unfortunately for Africa, however, “It’s not easy to stop it now,” Blackstone says.

“It’s going to take manpower and it’s going to take money. There’s also a big risk in people from West Africa traveling to other places, but the CDC has said it doesn’t want to cut off air traffic because that would limit people from getting in to help.”