The outbreak of Ebola in the West African countries of Guinea, Sierra Leone and Liberia is a tremendous health crisis for the world. First identified in 1976, there have been at least seven previous outbreaks. These were all contained in relatively small geographical areas and about 2,000 people were infected. All of the other outbreaks occurred in villages away from main population centers.
However, the epidemic we’re now facing started in Guinea in a village that was right on the border of Sierra Leone and Liberia. Patient zero was a 2-year-old boy who died on 6 December, 2013. By the end of March, it had reached Liberia, by the end of May, it spread to Sierra Leone. It was in Nigeria in July and in Senegal in August. It has reached the main population centers of Guinea, Liberia, and Sierra Leone.
The official WHO count of the infected is currently just over 9,000 with about half of those having died. However, the morality rate was raised to just over 70% and this reflects the lack of reliable numbers in countries whose health care systems have been devastated by the disease. My reading is that the actual number of current infections is about 20,000.
On the 30th of September, Thomas Eric Duncan, a man who returned from Liberia to visit his family in Dallas, was diagnosed with Ebola. He became America’s patient zero. He infected two of the people who nursed him in the hospital. On October 12, it was Nina Pham who came down with Ebola, and, on October 15, Amber Vinson.
My intuitive reading is that we’re not going to have a world-wide Ebola pandemic. Moreover, we’re not going to see any significant spread of the disease in the United States. Unless you are someone who works with currently infected Ebola patients, either in Africa the United States or elsewhere, you can rest assured you are going to die eventually of something else. But Ebola is not going to kill you or make you sick.
Ebola fits the archetypal expectation of a doomsday disease. It fits the picture of a science fiction scenario of humankind’s downfall resulting from the invasion and destruction of the natural habitats of plants and animals and the consequent migration of viruses living in animals to humans. We’re familiar with these themes from movies like Outbreak and the book Hot Zone.
In order to gain some perspective on the panic and irrational fear that this archetype of health doom can activate in us, it’s important to know some basic information about Ebola virus disease.
The best scientific information we have is that Ebola resides in fruit bats. The fruit bats drop fruit which the animals eat or defecate or drool on animals which then develop the disease. The humans find a dead animal in the forest or hunt the bats for food and the virus jumps from animals to people. The cause of the current epidemic is a single animal to human transmission.
Once infected, there is an incubation period of 2 to 21 days before any symptoms occur. The average time for symptoms to appear is 8 to 10 days. The first symptoms are fever, sore throat, headache, muscle pain and fatigue. It looks initially a lot like a flu bug. These symptoms are followed by diarrhea, vomiting and massive fluid loss. A person can lose 10 to 20 liters a fluid a day at this stage.
The final stage is low blood pressure, organ failure, coma and death. External and internal bleeding can occur at this stage and has been reported in 18% of the cases.
The virus particles attach themselves to the inside of blood vessels compromising them and the patient loses water, electrolytes, and other nutrients. If the person doesn’t recover, death occurs within about a week or two weeks from the onset of the first symptoms.
Ebola is transmitted from person to person when a previously uninfected individual has contact with the body fluids of the patient or touches the skin of the patient. It still needs entry to the body through a cut in the skin or body opening like mouth, nose, or eyes. However, once you get the virus on your hands, it can get into the body relatively easily since people are often touching their faces.
At the later stages of the disease, viruses are present on the skin and the skin may also be contaminated with the body fluids of the patient. The body of a person who has recently died of Ebola is a significant infection risk.
The Center for Disease Control has put out information that says that Ebola is not an airborne disease and that it’s not spread by coughing or sneezing. Therefore, you can’t get it from causal contact like sitting next to someone in an airplane. Scientists who study these types of diseases say that the chances that Ebola will mutate into an airborne disease are basically nil and that we shouldn’t be worried about that prospect.
However, there has been significant cognitive dissonance between the information that has come from official sources like the CDC and the images we see in news reports featuring people in hazmat suits disinfecting everything in sight including the sidewalk.
Ebola is a Level 4 biosafety disease. The biosafety level is determined by how dangerous a disease is with regard to its fatality rate, how infectious it is, and the lack of current cures, treatments, and vaccines. By comparison, plague and rabies only rate Level 3. There is no Level 5.
Because of the biosafety level, anyone doing research on Ebola has to be covered from head to toe in protective equipment. People dealing with Ebola patients are also supposed to be similarly covered in personal protective garb.
When Thomas Eric Duncan was diagnosed with Ebola, Thomas Frieden, the head of the CDC, said “we’re stopping it in its tracks in this country.” He further said any hospital with isolation capabilities could care for an Ebola patient. Then two nurses that worked with Duncan came down with the disease.
It’s helpful to track what happened with Thomas Duncan at Texas Health Presbyterian. Duncan apparently got infected when he carried a sick person back to their apartment in Liberia when they were refused admission to a hospital because there was no room. He gave false information about having had contact with an Ebola patient and flew to Brussels and then eventually to Dallas. He had no symptoms at the time.
He went to the emergency room at THP on the 25th of September. Although he disclosed that he had recently been to Liberia, he did not say that he had had contact with an Ebola patient. He was sent home even though he had a temperature of 103 degrees. He returned on the 28th and sat in the emergency room for three hours. Then he was put in isolation. For two days he was treated by nurses who did not have full protective gear.
Even after his diagnosis on the 30th, the protective gear was not initially adequate. Moreover, the nurses were not given sufficient instructions on safety protocols such as how to put on the gear and remove it. There was no plan in place for how to deal with the toxic waste that accumulated.
The United States has four facilities that are specialized and practiced in dealing with Biosafety Level 4 diseases. Altogether they can accommodate a total of 9 patients. Pham and Vinson have since been moved to these facilities.
Before she was diagnosed, Vinson flew from Dallas to Cleveland and then back to Dallas. She called the CDC and asked if she should fly back to Dallas since she had a fever of 99.5. But they gave her the go ahead since 101.5 was considered the threshold for a possible Ebola symptom. They have subsequently lowered the threshold to 100.4.
Vinson was diagnosed the day after she returned and fear spread. Two schools were closed in Ohio because an employee had flown on the same airplane as Vinson, although not even on the same flight. Three schools were closed in Texas when it was learned that students were on the same flight with Vinson.
The Louisiana State Attorney General obtained a restraining order to prevent incinerated waste from the apartment where Duncan stayed from being buried in a Louisiana landfill.
Senator Rand Paul did his part to increase the fear by first speculating about whether or not we’re going to have a pandemic.
Then he stated that the government was lying about the risk factors with respect to Ebola not being spread through casual contact because the CDC said you should avoid being within three feet of a person with Ebola for a prolonged period of time without protective equipment.
He speculated it could be transmitted through coughing. In his mind, if this is the close contact you should avoid, then we’re potentially at risk from sitting next to someone in an airplane, for example.
We can see now that we’re dealing with both incomplete information and disinformation about Ebola. Incomplete information with respect to communicating the basis for the risk assessment we’re facing with Ebola and disinformation from people like Rand Paul who have something to gain by distorting the true story and blowing it out of proportion.
The confusing messages we’re getting about Ebola are partly a result of our current governmental dysfunction. It would be great if we had someone of trusted authority, say, for example, a Surgeon General, that could be instrumental in clearing the air of misconceptions about Ebola.
However, we don’t have one because the Senate has never brought President Obama’s nominee for that post up for a vote due to concerns that his choice would offend the NRA. Putting Thomas Frieden, the head of the CDC, in that role is unfair to him because he’s not trained to be a public spokesman.
Although there is a lot we still don’t know about Ebola, there have been studies that established some basic scientific consensus about the disease. President Bush initiated some of the research on Ebola fearing it could be used as a bioterror weapon. Research was cut back due to political wrangling over the budget but a substantial amount was still done.
What we do know is that during the incubation period between the time the person is infected and develops the first symptoms, they are not contagious. This is because the virus hasn’t had a chance to as yet fully ramp up its exponential replications in the human body. It’s barely present in the blood at this point and not present in other bodily fluids. It doesn’t even reach the threshold of detection until the first symptoms appear.
People become more and more infectious as the disease progresses. Thus the CDC guidelines of avoiding prolonged close contact with someone that has Ebola by staying three feet away makes sense because you don’t want to touch the person or even touch what they have touched nearby.
Rand Paul’s hysteria about the “incredibly contagious” Ebola fails to take in account the level of illness of the person with the disease.
With respect to spreading Ebola through coughing, CDC studies show no evidence that this is a factor. In previous Ebola outbreaks, the people who got the disease were uniformly the ones who touched and cared for the patients, but not others who lived in relatively tight quarters. Some of these patients had coughs. This supports the statement that Ebola is not transmitted by airborne means.
None of the Duncan’s relatives become sick even though they were in small apartment with him. Their 21 day period of isolation ended on October 19.
With respect to the Ebola virus mutating into something that is airborne, this is a theoretical possibility that would support a science fiction scenario. But it is not very feasible from the standpoint of biological science. In a pathogen that already affects human beings, a basic change in the method of transmission has never been observed.
The virus would have to rebuild itself from the ground up to accomplish such a change, and it is under no evolutionary pressure to undergo that much modification, if this is even possible.
We don’t have to be worried about who you’re sitting next to on the bus or in the airplane. If they are infectious enough to be a real risk to you, they aren’t going to be on mass transportation.
With respect to the future of Ebola, my reading is that the current outbreak is going to be contained some time in the spring of 2015. The total number of infected people will be less than 50,000.
There have been only 4 countries outside of the three West African countries where Ebola has spread. Nigeria and Senegal have already contained their infections and have reported no new infections. Spain had one person who got ill treating an Ebola patient similar to the nurses in Dallas. She has since recovered.
My reading is that we’re not going to see any more than one or two more cases in the United States during this epidemic outside of people who come from Africa for treatment. The temperature screenings of people at airports is an effective deterrent although it can’t stop people without symptoms who develop them later.
Resources are starting to pour into the affected countries and more care units are being built.
Treatments and vaccines are on the way as the current crisis gives research into Ebola a huge kick in the butt. There is already the blood transfusion treatment from people who have recovered and hence have antibodies to the virus. In addition, more Zmapp is on the way.
Zmapp is a process whereby antibodies are grown in mice and then bioengineered into tobacco plants.
There is TKM-Ebola, a RNA interference drug, that is being tested. Four other anti-viral drugs that have also shown some promise.
Two vaccines are in human trials and a third is being developed. There are three separate research firms developing rapid diagnostic kits which can tell if a person has Ebola in ten to fifteen minutes.
It’s a good thing that we have an opportunity to test out these new vaccines and therapies, but it’s not going to do that much to alleviate the toll in Africa. I see that doubling what we have now at 20,000 cases.
When the crisis has passed and we reflect on the meaning of this event, an important element will be crisis information management. It was handled badly in the United States and unnecessary panic and fear resulted.
Part of the problem is that our understanding of Ebola virus disease is far from complete. The Biosafety Level 4 issues make research and data collection hazardous.
The scientific consensus narrative of what Ebola is and how it is transmitted is not going to be sufficient to allay the fears of people who get fragmentary information at best or who are influenced by self-serving agents of disinformation at worst.
For example, scientists speak in terms of probabilities. So they would say that there is very low risk of someone who has Ebola but has no symptoms or is in the very first stages of symptoms posing a risk to others through casual contact without body fluid transmission.
They would say that the prospect that Ebola could mutate into an airborne disease is extremely improbable, but not that it’s impossible.
But very low risk is not the same as no risk. When panic and fear are aroused, what is possible morphs into reality.
The next big shock about the Ebola virus disease will be the revelation that, in 5% of the cases, the incubation period between infection and first symptoms is longer than 21 days. People who have been in isolation for 21 days without symptoms pose very low risk to others of having Ebola. But, again, very low risk is not equal to no risk.
It makes sense to me that Obama would appoint a political figure as Ebola czar who can coordinate responses and be responsible for information management. Perception management is a political skill not something that scientists and doctors have particular expertise in.
My reading is that the 21 days is a sufficient isolation time period to keep us out of any realistic threat from sleeper Ebola patients. You have to weigh the benefits of excess caution with the consequences of drawing too big a circle around the problem.
If the isolation period is increased to 42 days, for example, this will make it more difficult to get the cooperation of the people who need to be isolated. Similarly, banning travel from the afflicted African countries will only encourage people to evade the restrictions and lie about their histories in West Africa making contact tracing more difficult.
Moreover, this still won’t eliminate every possible threat of infection because there are some people who have the virus but show no symptoms at all.
We’re all subject to irrational fears when emotional activations shortcircuit the higher centers of the brain. I’ve found it’s helpful to have some way of dealing with unreasonable fear and bringing things back into realistic perspective.
I call my application SORTA which stands for Spiritual Opening to Realistic Threat Assessment. This is how it works. When I’m possessed by a fear that is probably excessive and unwarranted, I want to know if it’s a real threat or not.
For example, I’m headed for the bank at the last minute. Should I be worried about getting there on time? I take a deep breath and, as I exhale, I envision a grounding rod going through my body into the mineral kingdom of the earth.
Then I ask my Higher Self, Is this threat real? Is this so? I assume that there is an aspect of myself that has more grounded information that is presently available to my emotionally addled brain and mind and I call on that aspect with a direct question. Then, if the fear proves unfounded, I can relax and proceed to my destination efficiently without putting myself at risk for a panic induced blunder.
In summary, my reading is that the world is going to contain this disease not later than the middle of next year. There will be new outbreaks from time to time from new animals to human transmissions, but we’ll be much better prepared to contain these new sources of Ebola.
We’re going to be safer and wiser in the long run because we’ll have the science and the technology to cope with future epidemics, even new Biosafety Level 4 threats that are still out there. The chance that these diseases could be made into bioweapons is greatly diminished for the future.
I’m less confident that, as a world community, we’ll take in the lessons of Ebola and become a more just and ecologically intelligent society as a result. This epidemic went out of control because the World Health Organization and others who might have been able to intervene effectively at the beginning did not respond in time with the resources needed.
Sadly, I feel this is due in no small part because the affected people were impoverished Africans.
If the Ebola epidemic teaches us anything, it’s that, as a community of nations, we’re all living on one small globe where the numbers of interactions we have with each other increase year by year so that whatever crisis affects one nation eventually affects us all.