dailybeast | But what about Ebola? The Dallas case is breaking some of our
ironclad assumptions. The CDC has a well-considered algorithm that
places those returning from the three endemic West Africa
countries—Sierra Leone, Guinea, and Liberia—into a measure of extra
vigilance if and only if the person has had exposure to a known case of
Ebola. Per the press conference, the Dallas case had no such exposure.
He was not a health-care worker treating patients, nor was he from a
family battling active disease. Of course, more facts may emerge that
contradict today’s story—but today’s facts, if they hold up, mean that
yesterday’s assumptions are no longer correct. Liberia may indeed be
enough of a hotbed of Ebola that anyone arriving from the area will need
to be considered for extra vigilance.
More disturbing, though, is
this: Infections follow basic rules. That’s what informs the confidence
of public health experts. TB, for example, is spread when I inhale the
exhaled breath of a person with active disease. Cholera and typhoid
fever are transmitted when I ingest contaminated food or drink. And
blood-borne infections like HIV, hepatitis B, and Ebola are spread after
contacting infected blood or having sex with an infected person.
But
even according to these basic rules, Ebola is slightly different in a
way that remains obscure. HIV is not spread easily: The per-sexual
exposure with an infected person is on the order of 1 in 100; a
needlestick with blood from an infection person sustained by a
health-care worker transmits infection in only 300 exposures.
Hepatitis B plays by the same rules, though the rates of transmission
are about 10 times more frequent. In other words, the likelihood of
catching HIV or hepatitis B from an infected person, even with a blood
or sexual exposure, is quite low.
Exposures
to Ebola, however, seem to leave no room for error. Although we lack
carefully performed studies, Kent Brantly, the physician who developed
the disease and was airlifted to Atlanta, seemed to have no gross
exposure to the disease, though he worked on an Ebola ward. Ditto for
Nancy Writebol the other American flown back in that dramatic first
wave. According to reports, they were mighty careful at every step, but
just not careful enough.
In contrast, it is said that absolutely
no one working for Médecins sans Frontières, or Doctors Without Borders,
has come down with Ebola, though they have been and are working cheek
by jowl with the same patients, presumably because they are perfectly
and methodically garbed and attentive 100 percent of the time, not 99
percent. So Frieden’s message to America surely is correct—we are 1,001
disasters away from an alarming national outbreak; our health-care
systems are indeed quite sturdy.
But his message to those caring
for the Dallas patient both in his home and now in the hospital needs a
bit of punching up. For once, all those rules about assuring that masks
fit and gloves (two pairs) are snug and gowns are tied and all the rest
are deadly serious, as is the mechanical sequence of doffing the
disposable garb, then washing hands carefully. This time, even in the
freewheeling city of Dallas, the rules must be followed carefully, as if
one’s life depended on it—because when dealing with Ebola, it does.
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