October 2014
Ebola
There is enough chatter about Ebola virus in the news lately to sound like a bunch of cackling hens. There are a lot of experts saying things that are just plain wrong about Ebola.
Ebola hasn’t been around that long and there have only been a few thousand cases. With a mortality rate approaching 80-90%, it is hard to find human test subjects to develop good data or vaccines. In order to understand a disease, we need hundreds of thousands of subjects from which to use data for analysis. For instance, coronary artery disease is well managed and understood because millions of subjects in many studies have provided the data over a 60 plus year time period from which we have determined the best treatment.
Catching Ebola
One thing that is glaringly obvious is that these experts are lying by omission. Respiratory transmission means that an infected and contagious individual might cough or breath hard causing microdroplets of saliva and mucous to aerosolize in the air. This contagion laden “mist” is then breathed in by a susceptible host and if that host’s immune system is thwarted, the infection is transmitted. The experts are allowing the public to think that contagion laden air just exists out there like a naturally occurring gaseous vapor.
Some idiot has spread the false concept that Ebola is not transmitted by the respiratory route. This is absolutely false. Ebola is transmitted by contact with body fluids. That means coming in contact with feces, urine, vomit, saliva or mucous (we can disregard the other body fluids for all practical purposes). Coughing is one of the symptoms of Ebola. During the cough, blood, mucous and saliva are aerosolized and spewed from the infected patient’s mouth and nose into the atmosphere and anyone standing close enough will be exposed. Now, Ebola may not be as contagious as, say, influenza, but contact with body fluids will occur in a respiratory manner to anyone in the vicinity.
Screening for Ebola
So the experts are going to “screen” for Ebola in people leaving one of the endemic areas by taking their temperature. A febrile illness (any illness where fever is a component) is not febrile every second of the illness. The fever usually occurs cyclically about every 2-6 hours for 12-72 hours of the peak of the illness. So, let us presume the unfortunate patient that recently died in Dallas was allowed to come to America because he didn’t have a fever. Well, he didn’t when they checked. But it takes 10-12 hours to get from West Africa to the US and he could have had a fever at any time during his travel. Our patient was spreading the infection to any and all of his fellow travelers.
Looking for Ebola in the US
The CDC and other “experts” are scrambling to provide health care workers, like me, with white papers on how to screen our patients for possible Ebola, so that if we have forgotten how to research an unusual disease or illness, we won’t be out there treating blindly. But, there is a problem with their offerings.
The CDC (Centers for Disease Control) and the ASPR (Assistant Secretary for Preparedness Response) have identified persons with the following as being suspicious for Ebola virus disease.
1. Fever, headache, joint and muscle aches, fatigue, diarrhea, vomiting and lack of appetite and
2. Travel to West Africa within the last 21 days
One doesn’t have to read too closely to see that those are the exact same symptoms as influenza and several other illnesses. We are told to quarantine suspect patients who have been to or been exposed to persons who have been to West Africa and have any of the symptoms of the flu. Since influenza has a penetrance of about 90% of the population, anyone that has been to or been in contact with anyone who has been to West Africa will be quarantined.
About 100-150 people per week come to the US from West Africa. They get here on an airplane that holds about 100-200 people. They walk through airports that have about 50-3000 or more people in them at any one time. They commute through cities that have populations of…
I hope you get the picture by now. Health care facilities are expected to provide private rooms with separate bathroom facilities from the moment we identify their risk. We have to provide reverse isolation for contact (and in my opinion respiratory) contagion. That means that anyone entering the room must dress in an impermeable covering of their entire body and remove this gear on exiting into an isolation container to be burned upon disposal. Every time they enter the room. It is impossible for the healthcare facilities to quarantine all these patients in any efficient manner.
You Can’t Come Here
We are being told that restricting travel among suspects with a deadly contagious disease is impossible, therefore if the contact of an Ebola patient or someone with suspected Ebola virus disease is here in the US, they will be quarantined. If the subject tries to not obey the quarantine, law enforcement will enforce the quarantine. Is that not restricting travel?
In 1918, a pandemic of H1N1 influenza devastated the population. It was traced back to 2 farm boys from Kansas that joined the Army and traveled to training camp and on to the front lines in Europe. Allowing that emigration caused the deaths of more than the entire loss to combat in WWI. There was more economic loss and imposition on every faction of life and disruption of living standards than any epidemic known to man. The death toll of the 1817 influenza epidemic was about 45%, as opposed to 80-90% for Ebola.
There are several states in the US that will not let you bring certain plants or animals into the state. California and Hawaii come to mind. I can remember being stopped at a border inspection station (California Department of Agriculture) and interrogated as to whether or not I was transporting certain contraband, every time I drove to California.
It is against the law to transport fine scotch whiskey from Scotland into the US if it hasn’t been through inspection and, more importantly, the taxing process. Somehow, the choice is not that hard for me. On the one hand, is Ebola with an 80-90% mortality and a good scotch with 80-90% chance of enjoying the hell out of it regardless of the outcome.
Bet you never thought about any of this.
From your favorite grumpy Uncle/Brother Dave.
Weary