Today the first man to be diagnosed with Ebola in the United States died in a Dallas hospital. That news, of one Liberian man’s death, is really just that: a mortality statistic, and a sad one at that.
But the inability to save Thomas Eric Duncan, age 42, points to the devastatingly lethal potential of this once rare virus. Given that Ebola is spreading – it’s crossed the Atlantic and the Mediterranean – and even if it weren’t here in America – his death highlights the need to deal with this epidemic head-on, for the sake of people in western Africa, and ourselves.
Health care workers are, understandably, anxious about catching this virus. Hospital-acquired infections are notoriously hard to contain even when they’re not transmitted through copious amounts of bloody vomit and diarrhea, as characterizes active Ebola. Bacterial infections in hospitals are, most often, spread by hands and fomites – inanimate objects like doorknobs, remotes, keyboards or dollar bills (among countless examples). This is different.
As a mom and hematologist who worked with AIDS patients and in an AIDS lab before there were drugs for that disease, I can relate to these concerns. I used to worry about transmitting an infectious, blood-borne virus home to my family. I was cautious – and although I never shied away from my responsibilities – I made an effort and took time to be extra-vigilant. In those days before checklists, common sense played a role in my behavior: frequent hand-washing; minding not to put my fingers near my mouth (much easier in the days before cellphones), and that sort of thing.
handwashing (source: Wikimedia)
Ebola, which is not transmitted by air, does get around by blood and, possibly, dried blood. It differs from HIV in this regard; most AIDS patients don’t bleed profusely – even full-blown AIDS is usually not such a messy condition as Ebola. The same goes for hepatitis C – which by is, by blood, at least 10-fold more infectious than HIV. As for Ebola, I’m not convinced that we know its “R0” – the degree of infectiousness.
As much as there’s a danger in being overly fearful, there’s a danger in overconfidence.
In the absence of a U.S. Surgeon General, Dr. Tom Frieden at the Centers for Disease Control (CDC) has done a terrific job in communicating what’s going on and, in general, appropriately assuring the public. But the agency could be more up-front about what we don't know, and should offer more guidance for ordinary people about what they might do in homes, at work, in schools, in airports, prisons, churches, gyms and cafeterias – basically everywhere – to minimize their chances of catching and spreading Ebola.
To this end, the CDC might answer some questions. Straight answers from public health officials could affect the behavior and lives of ordinary people, including patients with other medical conditions:
1. Can Ebola be spread by food handlers? Think of typhoid Mary. (Note that typhoid, or cholera, differs from Ebola in that it’s caused by a bacterial infection, not a virus.) But either might be spread by contaminated feces. There’s a reason why my grandmothers feared raw vegetables, unpeeled fruit and uncooked foods. Because if someone has infectious diarrhea, or carries a germ on his or her hands, they might contaminate the food or beverages (and dishes).
2. Along those lines...Is it OK to eat salad in a restaurant? What about salad bars? And does heat – as might be applied by cooking – kill the Ebola virus? Homemakers and chefs, and guys in trucks and food stands around the world, might benefit from knowing the answer to this simple question.
3. Does Purell kill Ebola? This is a very practical matter, as not everyone is in a position to wash their hands before, say, eating a sandwich on a plane. And if Purell is insufficient, what might ordinary people do to stay clean?
4. Can you get Ebola from a toilet seat? Seriously. I was traveling earlier this week, and I couldn’t help but notice the women working in hotel and airport bathrooms – whose job it is to keep those places clean. The CDC might offer guidelines (in many languages, clearly translated) about what you shouldn’t touch. And if you or they do accidentally brush up against an unclean surface, what then?
The risk of the CDC and local health authorities not addressing this sort question is that toilets will be left unclean – and then the odds of spread from just a few cases would grow. And if the answer is that cleaning workers, and homemakers like hospital aides – all, should all be trained in how to use
These are just a few of my questions as a physician-mom-patient-homemaker.
Since around 1960, after the advent of antibiotics and polio subsided, we’ve lived – for the most part in the U.S – free from concern of rapidly-spreading contagious conditions with high death rates. That may be changing. Our near-sterile modern cocoon is no longer.
Maybe we need to re-think our attitudes about cleanliness and, in the absence of guidelines, invoke common sense. If there’s a serious, infectious virus that may spread by body fluids, including feces, basic hygiene practices - which many Americans have forgotten, or ignore - may prove life-saving.
My thoughts are with the family of Mr. Duncan, and others struggling with the disease now. At the same time, I’m keenly aware – by the facts of history of epidemics, and current modes of world travel – that it’s impossible to stop this sort of infection by quarantine. We have to stop it with science. Meanwhile, we need to take care, and be prepared, and not down-play risks.
