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Ebola in the U.S.: Maybe it’s Time to Panic a Little

The first official case of ebola in the U.S. has now been recorded after a Liberian man who was infected with the deadly pathogen, but not yet symptomatic, landed in a Texas airport in late September.

Thomas Eric Dunan is a 42-year-old Liberian national, who flew from the Liberian capital, Monrovia, to Brussels and from there boarded a United Airlines flight, which landed in Dallas (DFW) on Sept 20, 2014. Five days later, he was taken to Texas Health Presbyterian Hospital with a mild fever, and was shortly sent on his way with a superficial diagnosis and a prescription for antibiotics. In the few days that followed, his symptoms worsened. Family members with whom he was staying alerted EMTs. They returned Duncan to the hospital. And it was only then that healthcare providers looked closely enough at Duncan’s case to pursue decisive action.

Duncan, now quarantined was listed in serious but stable condition, claims he showed no symptoms consistent with Ebola infection when he departed from his native soil. Investigation and contact backtracking undertaken since Duncan has been officially diagnosed reveals that he helped carry an infected pregnant woman a few days prior to his arrival in the U.S.

Over the weekend of Oct. 3, Duncan’s condition worsened. He is not being treated with the experimental drug ZMAPP that saved the lives of two American medical missionaries who were transferred home after contracting the disease. According to a Reuters article, Duncan is “struggling to survive.”

Is it time to panic? Perhaps just a little bit …

Maybe the time to trade daily wardrobes in for hazmat suits has not arrived in the U.S. just yet. But certainly some serious scrutiny needs to be put to the cracks in screening protocols that Duncan’s case slipped through.

After lending aid to a symptomatic, and suffering woman just days before, Duncan easily passed through travel screening protocols at Roberts International Airport in Monrovia. Those protocols included a questionnaire, and physical examination conducted by medical workers on site. He showed no signs of symptoms, but ebola has an incubation period of two to 21 days. That means symptoms in an infected person may not present for as many as three weeks.

Duncan may not have been symptomatic when he traveled, but he was within that 21-day window. Since his official diagnosis, everybody he came in contact with has been quarantined. This time, those people will be closely be monitored for the requisite 21 days. If the same standards had been applied overseas, Duncan would never have been allowed to travel in the first place.

Admittedly, the west-African nations where ebola has been wreaking havoc for the last several months lack the resources and infrastructure to execute such airtight protocols. And it’s now being reported that Duncan lied about his history of contact on the airport questionnaire. Liberian officials are expressing outrage over it, and are now saying Duncan will face prosecution upon his return. But Duncan’s prosecution will come as little consolation to anyone who turns out to have been infected by him. And the potential ripple effects of contact presently fanning out through the Liberian community in Dallas — a community that includes Duncan’s friends and family —  are what is really scary. And since it’s unreasonable to expect poor countries to protect rich countries from pathogens their citizens export, then the burden logically falls on those countries — like the U.S. — where the systems should be capable of executing effective screening. And in our first trial run, we failed. While there may be heavy amounts of confidence in the American health care system’s ability to treat, cure and prevent infectious disease, none of those happen until after disease is detected, and after  we admit to a measure of vulnerability.

Who are these U.S. residents the CDC is now tracking?

As many as 114 People who may have come in contact with Duncan, including his girlfriend, her son, and two adult nephews, are being monitored by the CDC. Also included on that list are five school-aged children from four different schools. All of them are now being monitored from home. The children’s schools remain open, but they a major drop-off in school attendance is being reported.

Why we should panic

For now the ebola virus only spreads through direct contact with the bodily fluids — blood, sweat, tears, feces, urine, saliva — of infected people. But concern is mounting over the potential for the pathogen to mutate and become airborne. According to infectious disease experts cited by CNN, it is a potential that is being taken very seriously. Dr. Michael Osterholm, director of the Center for Infectious Disease Research, said he thinks nothing “… would be more devastating to the world than a respiratory transmissible Ebola virus.”  And because Ebola is an RNA virus, every time it makes a new copy of itself using the hijacked mitochondria of host cells, it makes one or two mutations. While most of those amount to nothing, Osterholm referred the scenario as a game of genetic roulette. There’s no way to predict how new mutations of the virus might alter its capabilities. All that is certain is that mutations will continue. According to the same CNN report:

“One group of researchers looked at how Ebola changed over a short period of time in just one area in Sierra Leone early on in the outbreak, before it was spreading as fast as it is now. They found more than 300 genetic changes in the virus.”

A little panic now might prevent catastrophe down the road.

U.S. medical systems are better funded, better developed, better educated and have more access to superior medications and treatment procedures. However, none of those factors prevented hospital staffers in Dallas from falling into the same thinking trap as medical workers in Liberia. Such a lapse may even be less forgivable expressly because of the superiority of U.S. medical systems. It’s an attitude of ‘innocent until proven deadly.’ With the Ebola outbreak in west Africa a consistently top-ranking news story since the epidemic was declared last March, the arrival of a west-African foreign national presenting symptoms consistent with Ebola, even though not acutely, should have alarmed someone. Even if hospital staffers who conducted Duncan’s admission screening weren’t particularly geographically savvy, or particularly invested in following the news, there should have been someone, somewhere along the chain of command to pick up on all the cues.

To make matters worse, the pharmaceutical company that manufactures the experimental drug ZMapp says its supplies have run dry and that there won’t be a new supply of the drug “anytime soon.” That’s one less advantage potential patients in the American medical systems can rely on.

The city of Dallas has a large Liberian immigrant community. Surely there must have been a memo, an email, or a hospital staff meeting in which contingencies like the one Thomas Eric Duncan presented were discussed. Those of us looking in from the outside will never really know what path the system followed to failure this time. Just the fact that it failed, after so many months of fair warning, should be cause for at least a little bit of panic.

 

Image source Flickr/usarmyafrica

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