Putting Ebola in Perspective

The media in our country seems unwilling to report the “back end” of the Ebola panic that they incited this fall.  They were more than willing to sensationalize the story, to the extent they could, but left out much that should have been addressed.

First let’s state that Ebola, in any of it’s varieties, is hard to transmit.  It is transmitted by direct contact with blood, vomit or stool.  There is a small amount of virus found in other body fluids such as tears, sweat, sperm, but the viral load in these areas is so low it has never caused transmission of the disease.  It is not transmitted by coughing, sneezing or breathing.  Reporters that indicated that someone could “cough” or “sneeze” and transmit the virus failed to mention that the amount of fluid necessary to do that would mean that instead of a sneeze, it was actually a person vomitting.  Ebola has never been transmitted by a sneeze.  Small airborne droplets will not transmit the virus.  Secondly, in the history of virology, there is no precedent for saying that the virus could mutate and “change” from a “direct contact” virus, to a “airborne transmission” virus.  It has never happened.  If the media can get away with that “it could change” line, well, we could also say that a human can sprout wings and fly.  Possible?  Sure.  Likely?  Not even remotely.  It’s absurd on the face of it. 

Let’s cover some of the timeline and point out some facts that are not sensational enough to report. The first victim in the United States was Dr. Kent Brantly.  He was medically evacuated from Liberia for treatment in Atlanta, Georgia.  His disease was known and he was transported and treated carefully.  Nancy Writebol was a co-worker of Dr. Brantly and she was transported and treated at the same time.  On August 21 both were discharged, virus free. 

Thomas Duncan, a Liberia native, was the first case diagnosed in the US.  He was the personal driver for an executive in Liberia.  Duncan abruptly quit his job on September 4, 2014.  He had received a visa and flew to the US to visit his estranged teenage son and the boy’s mother who had been his girlfriend in Liberia.  It is believed that he contracted Ebola on September 15, 2014 when he helped a pregnant neighbor get into a taxi to go to the hospital.  That  neighbor would later die of Ebola.  On September 19 Duncan went to the airport in Monrovia, apparently lied about contact with the disease (according to the government) and boarded a flight to Brussels and then on to Washington Dulles on United flight 951.  From there he took United 822 to Dallas arriving in the evening.  

Duncan became symptomatic on September 24, 2014 arriving at the hospital after 10pm.  With the nonspecific signs of fever and abdominal pain a workup was done including lab work, CT scans of the abdomen and head.  He was discharged home with other diagnoses.  On September 28, 2014 he returned to the hospital by ambulance.  He deteriorated quickly and was transferred to the ICU on September 29 (after all other patients were evacuated).  Duncan died on October 8. 

Two nurses took care of him, Pham and Vinson.  It is believed that up to 100 people came in contact with him AFTER he showed symptoms.  

Nina Pham was one of the nurses.  She started to feel poorly on 10/10/14  and tested positive for Ebola on 10/11/14.  On 10/16 Pham was transferred to Bethesda Maryland.  On 10/24/14 she was declared virus-free and left the hospital.  

Amber Vinson was the other nurse.  On 10/14/14 she reported a fever.  She tested positive on 10/15/14.  However, on 10/13/14 Vinson had flown Cleveland to Dallas on Frontier Airlines 1142.  She was declared virus-free and released on 10/22/14. 

Let’s stop here for a moment.  First, were there any people infected on the United flights from Africa?  No.  How about the domestic Frontier flights.  None.  How about any hospital contacts, personal contacts?  No.  Duncan was around over 100 people after symptomatic, are any of them sick?  None.  

Why is there almost no discussion about this LOW rate of transmission?  

The Ebola epidemic in Africa was horrible, but it topped out at 4-5000 dead and was already decreasing by late September, though this wasn’t reported in October and hasn’t been reported now.

In comparison to Ebola, malaria in Africa kills over 600,000 people each and every year.  Year after year.  Most deaths are among children.  We now, in our current state of “panic” are talking about spending billions of dollars on Ebola research.  Rarely is anything said about malaria that kills a magnitude 150 times more people year after year.  

In all, in the US, 2 people were infected who were caring for a sick and dying Ebola patient.  They were exposed to vomit, blood or stool or all three.  No one else that Duncan came in contact with, or the nurses came in contact with became sick.  He died due to delayed diagnosis.  They lived due to early diagnosis.  Ebola is a problem, but it is not the huge problem we make it out to be.  Travel does not need to be restricted.  Draconian measures do not need to be taken by TSA to further “screen” travelers.  We need, at some point, to have a reporter report the back-side of the story.  We need the public to be told that this is a disease that is hard to transmit.  

We do not need to divert resources to a disease that kills thousands, when there are diseases that are killing hundreds of thousands, and not randomly, each and every year.  

Jason R. Stokes, MD