Odler Robert Jeanlouie, MD
The case of Kaci Hickox is the straw that broke the camel's back.
A young nurse, Maine resident, went to Sierra Leone, Western Africa to take care of Ebola patients. To prevent an Ebola pandemic, the disease must be contained where it currently is, in Africa. The mantra would be "to fight it over there, in order to avoid fighting it here at home." The 33-year old healthcare professional was doing the right thing, being an American humanitarian.
After a few weeks of productive work, away from her family and from her boyfriend, Kaci Hickox returned to the U.S. She was eager to be home in Maine. Her international flight landed in New Jersey. She had no symptoms. Her temperature upon leaving Africa was within normal limits, but a temperature measured on her forehead (not a gold standard), at the airport, was found to be 101*F; later it was measured as normal.
Instead of the fanfare band welcoming her as a brave warrior with a lion heart, Kaci Hickox was picked up by the authorities, caged under a tent in Newark, in solitary confinement, solely covered with paper clothing. She was not offered a single magazine, a radio, or a TV. On Day 1, she was tested twice, by Rutgers University and by the Center for Disease Control (CDC). The blood test twice returned negative for antibodies.
Notwithstanding, she was refused access to her family away in Maine, and even to an attorney. In New Jersey, the Garden State, a jewel of Freedom Country, Kaci Hickox was treated like the worse of all criminals.
Her ordeal triggered a national uproar. Even the President intervened. The tribulation lasted four days; Kaci Hickox was eventually released from captivity. In Maine, she defied the governor's orders; she refused any form of quarantine. Eventually, a judge agreed with her; but she would have to follow the CDS recommendations. She would have to be available to the authorities for daily examination for possible onset of symptoms, and she would not leave the state until 21 days after her return to the US.
Nice ending to a horrible story. Unfortunately, Kaci is not alone...
Not everyone has the courage and the clout of Kaci Hickox. People who live in or travel to Western Africa are subject to much harassment caused by policies written by clueless public servants. Preventing an epidemics does not come from knee jerk reaction, or grandstanding for political benefits. It comes from scientific data.
As the New England Journal of Medicine (NEJM) reminds us in a recent editorial, the official reaction and public response to Ebola are quite reminiscent of the onset of the AIDS epidemics, with the 4H label, and the suggestion to place in concentration camp or to tattoo anyone with a positive test.
It should be clear to everyone that Ebola is not a deadly disease, like AIDS was in the 1980s. In the US, there has been nine cases of Ebola, only one patient died in Texas. He died because medical intervention was initiated too late. In Sierra Leone, Guinea Bissau, and Liberia, where health structures and resources are poor, out of 10,000 cases, almost half have survived!
Nine months after the first diagnoses, Ebola behaves more like an endemics than as an epidemics; it has remained confined to specific geographic areas. In Nigeria and Cote d'Ivoire, the index cases were identified; the disease was eliminated. Today, the two countries are officially free of Ebola, as per the World Health Organization (WHO).
The above data suggest that Ebola has a poor airborne transmission. Compare with the flu pandemic of 1918. In less than a year, it propagated to the entire world, and killed 50 million people, 675,000 in the US alone... By the way, the world population in 1918 was only one billion compared to today's seven billion. Moreover, transcontinental travel was minimal, commercial planes did not exist... A trip from New York to Paris that lasts six hours today, would last a week.
Take home messages:
The risk of an Ebola pandemics is insignificant at today's worldwide effort level. So we can drop that fear.
No one will contact Ebola unless they come in physical contact with a symptomatic patient. Symptoms include fever, cough, skin rash, and bleeding. A serum antibody test is available; it tells if someone has been infected or not, but no one knows for sure how long after the infection it turns positive.
A trip to Africa does not qualify automatically as a risk factor for infection. Africa is not a single country; it is a continent of 51 independent countries different from each other, as different as the US is from Nicaragua. Only some regions of Liberia, Guinea, and Sierra Leone are affected by the disease.
Quarantine of a traveler who has no symptom and who tests negative for the antibody should be limited to daily observation. She should be allowed to wander in the streets if she remains three feet away from everyone else.
Treatment of the patient with symptom is simple: isolation, optimization of calorie intake, and support with intravenous fluids. Monitoring and correction of blood tests (electrolytes, blood cells, coagulation factors) are also part of the process. Use of anti viral medications is selective. A vaccine is being tested.
The bottom line, you are quite unlikely to contact Ebola, unless your lover has it. If you do, you are very unlikely to transmit it or to die from it. If it were otherwise, half of the African population who have died by now. Therefore Christie, Cuomo, Jyndall and other American governors should take a deep breath, pour some water in their wine, consult physicians and scientists before they make any policy decision. They should reward healthcare workers who want to go to Western Africa to eradicate the endemics, and welcome them back as heroes, instead of jailing them under a tent with paper clothing on their back.
Indeed, no need to panic...
(OdlerRobert Jeanlouie, Saturday, November 8, 2014)