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Ebola in the USA - Should You Be Worried?

In a word, no, Ebola virus does not represent a significant threat to the United States in its present form. There is currently an outbreak of Ebola virus in Western Africa which has bcome more severe than any previously known outbreak of the disease and which has killed more than 60% of the 1600 people who have fallen ill with this disease. These statistics, coupled with a general fear of the disease, which is infamous for the excessive bleeding and pain that it causes victims prior to their deaths, have led to fears that this localized - but severe - outbreak could escalate and become a global pandemic. These fears have been further fed by localized instances where patients that had recently visited the countries where the outbreak is ongoing (Guinea, Sierra Leone, Liberia) presented with symptoms after leaving those countries on a plane. This leads to fears that these patients may serve as gateways for Ebola to enter into new countries. These fears have been further amplified in the USA lately as two American health care workers that had been stationed in Western Africa contracted Ebola and were transported back to the USA for treatment and observation. Despite advanced quarantine measures that were in place throughout the duration of their trips back to the US and their hospital stays, the fear of an ebola outbreak in the US has fed the public imagination with the help of the mass media, leading may people to wonder whether they should be worried about this looming viral threat. At present, hwoever, Ebola is unlikely to become an issue in the USA, although it is not impossible, making a public understanding of what the virus is and is not the most viable source for control in the unlikely event that the virus works its way into the general population.

Fortunately, Ebola does not spread as easily as many common viruses that do cause occasional pandemics, such as the influenza virus. Whereas the flu is communicable through the air if someone with a bad case of the disease coughs or sneezes, Ebola is more difficult to contract. Specifically, one must come into contact with the bodily fluids of the infected individual. While this reduces the odds of contracting Ebola unknowingly, the disease can cause severe vomitting in addition to the traditional bleeding in its victims, making sharing space with them dangerous if not properly prepared, even if one does not intend to make direct contact with the individual. Another fortunate aspect of the Ebola infection process is that the virus is only believed to be communicable while patients are symptomatic. Diseases such as the flu are often most contagious shortly before the onset of symptoms and remain infectious during the stages of the disease. Ebola, however, does not seem to share this capacity (although contact with the fluids of infected individuals is unwise no matter how recent their exposure, as a safety precaution). These two facts reduce the chances of contracting Ebola virus from a random person that makes their way into the USA or any other country - if such a person were to wander through Grand Central Station in New York but were not currently showing any symptoms, then everyone else in the travel hub would likely walk away unharmed. The risk of accidental contraction of the disease is very low, unless you are a health care worker that is interacting with patients who may themselves be infected with the virus.

As the epidemic has raged on in Western Africa, the local governments, in response to both internal and external pressures, have ramped up their efforts to effectively quarantine infected citizens and prevent the spread of the virus within their borders and beyond. There are still instances where these efforts are insufficient, as in the case of an infected woman who was broken out of quarantine by her family, even though the woman later died. Such incidents are a serious risk that could easily serve to compromise the quality of public health efforts to curb Ebola infections. These issues are further compounded by a lack of education with regards to the nature of the disease in the most severely affected areas. Recently, there have been efforts to stop locals from consuming or interacting with fruit bats, which are a natural carrier of the virus, but fully eliminating such voluntary actions is difficult given the limited number of aid workers in the region and the large local populace. A recent text message hoax circulating through the region further suggests that people may avoid contracting Ebola by chewing on bitter cacao seeds. While this claim is patently false, the text is widely circulated and it is possible that many people will believe the claim and will do as it says. While this claim alone will not harm people directly, it may cause them to act in otherwise dangerous ways that will increase their odds of being exposed to the disease. As such education and effective quarantine are both essential tools in the quest to curb the spread of a disease for which there is no reliable treatment or cure beyond experimental drugs and symptomatic care.

These factors that make Ebola ripe to spread in Western Africa are also what make it less likely to spread in the United States. For one, it is not known if the wild bats in the USA would be infected with the Ebola virus. If not, then this would limit the ability of the virus to spread other than through direct human contact. Indeed, the only real danger of the virus in the United States would likely come if it were able to establish itself within an animal reservoir from which it could spontaneously reemerge. Without such a reservoir in local bats or other wildlife, the virus would quickly die out in the US. While there are plenty of uneducated people in the USA who would no doubt believe extraordinary health claims from unverified sources, the more readily available access to technology and news would also hopefully enable more rapid reeducation efforts that would prevent people from acting in hazardous fashions. The current media attention given to the disease has likely increase public awareness and would thus be able to educate the public with regard to the warning signs of infection and the best practices needed to avoid getting themselves infected as well without causing unneeded panic.

In addition, the US government has authorized the use of quarantine for patients infected with hemorrhagic fever viruses such as Ebola in order to prevent their spread to the population as a whole. This means that anyone believed to be at risk of developing Ebola or currently sick with the disease could be locked in a health care facility. If they objected to being secured in such a facility, the military would be authorized to keep them there by force. While this is a frightening prospect, it is a necessary one, and the US military has sufficient strength to maintain an effective Ebola quarantine operation. In addition they would likely round up and monitor close contacts of the infected individuals, in order to catch them before they become contagious, if they are infected. By monitoring patients and their contacts, the government will be able to rapidly round up everyone in the country infected with the disease, thus stalling it before it can gain a stronger foothold. It is also likely that if someone in the US did contract the disease, the government would act to suppress this information through a variety of means in order to prevent the dangerous potential public outcry that could occur following such a revelation. If the outbreak were to spread then such misinformation tactics might prove dangerous and counterproductive, but in the instance of a single case that otherwise poses little danger to the public they would likely be justifiable.

Ebola is indeed a scary disease that conjures images of bleeding shambling corpses, however it does not represent the coming apocalypse that the mass media occasionally makes it out to be. It is a devastating illness, and the effect that it is currently having in Western Africa is appalling. This outbreak calls to light the urgent need for more research into the virus and into possible treatments such as the recent drug that was given to two moribund US healthcare workers sick with the disease in an experimental capacity. I believe that in the coming months this outbreak will be brought under control and will eventually die out, however more outbreaks are likely in the future and so such drug development efforts should remain imperative even after the harsh glare of the limelight fades away and life in the region returns to normal. Certainly, an outbreak in the USA is possible, but it is very unlikely. And even if such an outbreak were to occur, the government possesses the capacity to both quickly contain the outbreak and to improve public education about the outbreak. Hopefully such an outbreak never occurs in the US (or anywhere else, for that matter), but if it does it will not represent a lethal pandemic - life will go on as normal, and we will adjust to and eliminate the disease without suffering a severe or mortal blow in the process.

References

  • 1. Enserink, M., Ebola drugs still stuck in lab. Science, 2014. 345(6195): p. 364-365.
  • 2. Ansumana, R., et al., Ebola in Sierra Leone: a call for action. The Lancet, 2014. 384(9940): p. 303.
  • 3. Waddington, C., Ebola outbreak in Guinea: a different type of regional stability threat: West Africa-issue in focus. Africa Conflict Monthly Monitor, 2014: p. 47-51.
  • 4. Green, A., West Africa struggles to contain Ebola outbreak. The Lancet, 2014. 383(9924): p. 1196.
  • 5. Parkes-Ratanshi, R., et al., Ebola Outbreak Response; Experience and Development of Screening Tools for Viral Haemorrhagic Fever (VHF) in a HIV Center of Excellence Near to VHF Epicentres. PloS one, 2014. 9(7): p. e100333.
  • 6. Vogel, G., Are bats spreading ebola across sub-saharan Africa? Science, 2014. 344(6180): p. 140-140.
  • 7. Ayithan, N., et al., Ebola Virus-Like Particles Stimulate Type I Interferons and Proinflammatory Cytokine Expression Through the Toll-Like Receptor and Interferon Signaling Pathways. Journal of Interferon & Cytokine Research, 2014. 34(2): p. 79-89.
  • 8. Gatherer, D., The 2014 Ebola virus disease outbreak in west Africa. Journal of General Virology, 2014: p. vir. 0.067199-0.
  • 9. Du Toit, A., Ebola virus in West Africa. Nature Reviews Microbiology, 2014. 12(5): p. 312-312.

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