“Ebola Was Already Here”: How The United States Contains Deadly Hemorrhagic Fevers
The Centers for Disease Control and Prevention announced Tuesday the first diagnosis of Ebola in a person in the United States. The man was admitted to a hospital in Dallas after traveling from West Africa. In August, infectious disease specialist Tara C. Smith wrote about how the United States stops the spread of diseases that are similar to Ebola. The original article is below.
It’s odd to see otherwise pretty rational folks getting nervous about the news that the American Ebola patients are being flown back to the United States for treatment. “What if Ebola gets out?” “What if it infects the doctors/pilots/nurses taking care of them?” “I don’t want Ebola in the United States!”
Friends, I have news for you: Ebola is already in the United States.
Ebola is a virus with no vaccine or cure. Any scientist who wants to work with the live virus needs to have biosafety level 4 facilities (the highest, most secure labs in existence, abbreviated BSL-4) available to them. We have a number of those here in the United States, and people are working with many of the Ebola types here. Have you heard of any Ebola outbreaks occurring here in the United States? Nope. These scientists are highly trained and very careful, just like people treating these Ebola patients and working out all the logistics of their arrival and transport.
Second, you might not know that we’ve already experienced patients coming into the United States with deadly hemorrhagic fever infections. We’ve had more than one case of imported Lassa fever, another African hemorrhagic fever virus with a fairly high fatality rate in humans (though not rising to the level of Ebola outbreaks). One occurred in Pennsylvania, another in New York just this past April, a previous one in New Jersey a decade ago. All told, there have been at least seven cases of Lassa fever imported into the United States—and those are just the ones we know about, people who were sick enough to be hospitalized, and whose symptoms and travel history alerted doctors to take samples and contact the Centers for Disease Control and Prevention. It’s not surprising this would show up occasionally in the United States, as Lassa causes up to 300,000 infections per year in Africa.
How many secondary cases occurred from those importations? None. Like Ebola, Lassa is spread from human to human via contact with blood and other body fluids. It’s not readily transmissible or easily airborne, so the risk to others in U.S. hospitals (or on public transportation or other similar places) is quite low.
OK, you may say, but Lassa is an arenavirus, and Ebola is a filovirus—so am I comparing apples to oranges? How about, then, an imported case of Ebola’s cousin virus, Marburg? One of those was diagnosed in Colorado in 2008, in a woman who had traveled to Uganda and apparently was sickened by the virus there. Even though she wasn’t diagnosed until a full year after the infection (and then only because she requested that she be tested for Marburg antibodies after seeing a report of another Marburg death in a tourist who’d visited the same places she had in Uganda), no secondary cases were seen in that importation either.
And of course, who could forget the identification of a new strain of Ebola virus within the United States. Though the Reston virus is not harmful to humans, it certainly was concerning when it was discovered in a group of imported monkeys. So this will be far from our first tango with Ebola in this country.
Ebola is a terrible disease. It kills many of the people that it infects. It can spread fairly rapidly when precautions are not carefully adhered to: when cultural practices such as ritual washing of bodies are continued despite warnings, or when needles are reused because of a lack of medical supplies, or when gloves and other protective gear are not available, or when patients are sharing beds because they are brought to hospitals lacking even such basics as enough beds or clean bedding for patients. But if all you know of Ebola is from The Hot Zone or Outbreak, well, that’s not really what Ebola looks like. I interviewed colleagues from Doctors without Borders a few years back on their experiences with an Ebola outbreak, and they noted:
As for the disease, it is not as bloody and dramatic as in the movies or books. The patients mostly look sick and weak. If there is blood, it is not a lot, usually in the vomit or diarrhea, occasionally from the gums or nose. The transmission is rather ordinary, just contact with infected body fluids. It does not occur because of mere proximity or via an airborne route (as in Outbreak if I recall correctly). The outbreak control organizations in the movies have no problem implementing their solutions once these have been found. In reality, we know what needs to be done, the problem is getting it to happen. This is why community relations are such an issue, where they are not such a problem in the movies.
So, sure, be concerned. But be rational as well. Yes, we know all too well that our public health agencies can fuck up. I’m not saying there is zero chance of something going wrong. But it is low. As an infectious disease specialist (and one with an extreme interest in Ebola), I’m way more concerned about influenza or measles or many other “ordinary” viruses than I am about Ebola. Ebola is exotic and its symptoms can be terrifying, but also much easier to contain by people who know their stuff.
“Irrational Fears”: Ebola Shouldn’t Be The New Political Football
A couple of weeks ago, President Obama traveled to the Centers for Disease Control and Prevention in Atlanta to unveil an ambitious U.S. response to the Ebola outbreak in Africa, including money, materials, and military and health personnel. Almost immediately, the right started complaining bitterly.
“We are sending more soldiers to fight Ebola than we are sending to fight ISIS or other Muslim terrorists,” Rush Limbaugh told his listeners. “I didn’t know you could shoot a virus. Did you?”
Now that an Ebola case has been diagnosed in the United States, the right’s politicization instincts are kicking in once more. Fox News’ Steve Doocy went so far as to suggest the CDC may not be entirely trustworthy – it’s part of the Obama administration, Doocy said, which Fox News viewers believe “has misled a lot of people on a lot of things.”
And then there’s Sen. Rand Paul (R-Ky.), who’s worried about Ebola and “political correctness.”
[Paul] on Wednesday questioned President Obama’s decision to dispatch 3,000 U.S. troops to West Africa to help combat the Ebola virus.
“Where is disease most transmittable? When you’re in very close confines on a ship,” Paul said on Laura Ingraham’s radio show. “We all know about cruises and how they get these diarrhea viruses that are transmitted very easily and the whole ship gets sick. Can you imagine if a whole ship full of our soldiers catch Ebola?”
The senator specifically added, “I really think it is being dominated by political correctness.”
Also yesterday, Paul talked about Ebola with Glenn Beck – because, you know, that’s what U.S. senators and prospective presidential candidates do – and argued that the public may not be frightened enough. “I do think you have to be concerned,” the Kentucky Republican told Beck. “It’s an incredibly transmissible disease that everyone is downplaying, saying it’s hard to catch…. I’m very concerned about this. I think at the very least there needs to be a discussion about airline travel between the countries that have the raging disease.”
I’ll assume the senator isn’t recommending a flight ban for Dallas.
Because Rand Paul has a medical background, some may be more inclined to take his concerns seriously on matters of science and public health. With this in mind, it’s probably worth noting that the senator, prior to starting a career in public office four years ago, was a self-accredited ophthalmologist before making the leap to Capitol Hill.
So when Paul compares Ebola to an ailment that is “transmitted very easily,” and describes the virus as “incredibly transmissible,” it’s a mistake to assume the senator knows what he’s talking about. There are actual medical experts and specialists in the field of transmittable diseases – and the junior senator from Kentucky isn’t one of them.
If Paul were just a little more responsible, he wouldn’t make public comments like these at a time when many Americans already have irrational fears.
As for concern for the safety of U.S. troops, CNN reports that the Pentagon does not expect servicemen and women to come in direct contact with Ebola patients as part of the American response to the African outbreak.
By: Steve Benen, The Maddow Blog, October 2, 2014
“A New Round Of Conservative Complaints”: Even A Response To Ebola Can Apparently Be Politicized
President Obama traveled to the Centers for Disease Control and Prevention in Atlanta this week to unveil an ambitious U.S. response to the Ebola outbreak in Africa, including money, materials, and military and health personnel.
It’s one of the most aggressive responses in U.S. history to a disease outbreak. Michele Richinick reported that “as many as 3,000 military personnel will assist in training new health care workers and building treatment clinics in the countries affected by the disease,” and some of our financial resources will be used to “construct 17 new treatment centers, each with 100 beds, and 10,000 sets of protective equipment and supplies to help 400,000 families protect themselves from the epidemic that is spreading exponentially.”
A day later, the United Nations secretary general, Ban Ki-moon, announced plans to establish “a new on-the-ground mission in West Africa to coordinate the struggle against Ebola,” while the World Bank Group issued a report warning of a “potentially catastrophic blow” to the economies of countries like Liberia, Sierra Leone, and Guinea.
Given all of this, it seems like an odd time for conservative media to start a new round of complaints.
Right-wing media are using President Obama’s plan to fight the Ebola outbreak in West Africa as another opportunity to attack him. Conservatives are calling the president a “hypocrite” because he’s sending “more soldiers to fight Ebola than we are sending to fight ISIS”; labeling the plan “arrogant” because of problems with HealthCare.gov; and accusing him of trying to “change the subject” by “fighting a really bad flu bug.”
It was former Rep. Allen West (R-Fla.) who equated the Ebola virus with a “really bad flu bug.”
Rush Limbaugh added, “We are sending more soldiers to fight Ebola than we are sending to fight ISIS or other Muslim terrorists…. I didn’t know you could shoot a virus. Did you?”
For what it’s worth, there’s a credible argument to explain why a military component should be part of the response to an outbreak like this. Julia Belluz had an interesting piece on this yesterday, noting the larger debate.
Obama has repeatedly referred to the threat of Ebola in security terms, arguing the virus could cripple the already fragile economies in the African region. He’s made the case that this will have consequences for not only the security of countries there, but also for nations around the world – even if the virus doesn’t spread beyond Africa.
For examples of this war-like mentality, look no further than the president’s address, delivered Tuesday from the Centers for Disease Control headquarters in Atlanta: “If the outbreak is not stopped now, we could be looking at hundreds of thousands of people infected, with profound political and economic and security implications for all of us. So this is an epidemic that is not just a threat to regional security – it’s a potential threat to global security if these countries break down, if their economies break down, if people panic. That has profound effects on all of us, even if we are not directly contracting the disease.”
It’s a fairly easy argument to make. There are critics of the “securitization” of these public-health crises, but in countries facing “potentially catastrophic” economic and destabilizing conditions, it’s not hard to imagine unrest and possible violence.
The point is not to “shoot a virus”; it’s to create conditions in which people who contract the virus can receive care.
By: Steve Benen, The Maddow Blog, September 18, 2014
“Right-Wing Xenophobes Are Spreading Lies About Migrant Diseases”: Latest Chapter In An Ugly History Of American Nativism
Citing the “potential threat of communicable diseases,” the city council in League City, Texas, voted last week to ban undocumented children from entering the Houston suburb. In Murrieta, California, Mayor Alan Long claimed that the government was placing “ill and contagious” kids in its midst. Even national politicians who should know better—namely, House Republicans—are spreading lies and paranoia. Phil Gingrey, in a letter to the Center for Disease Control and Prevention, wrote that “deadly diseases” threaten “Americans who are not vaccinated—and especially young children and the elderly.” And Randy Weber said, “We’re thinking these are diseases that we have eradicated in our country and our population isn’t ready for this, so for this to break out to be a pandemic would be unbelievable.”
There’s a legitimate policy debate to have over the border crisis, but it must begin with the facts. Doctors have debunked claims of diseased-ridden children: The migrants tend to be middle class with updated vaccines. By engaging in this right-wing fear-mongering, the aforementioned elected officials—and many others—are earning their ignominious place in a long, ugly history in American nativism that demonizes immigrants under the guise of public-health concerns.
With each wave of immigration, nativists have made public-health excuses for keeping out migrants. In the 1830s, cholera was described as an “Irish disease,” and in the late 1800s Tuberculosis was portrayed as a “Jewish disease.” In 1891, Congress banned any immigrant “suffering from a loathsome or dangerous contagious disease.” Even at Ellis Island, a site we celebrate as America’s front door for the “tired and weary,” medical inspections were a weapon aimed at immigrants who traveled on second and third class and were commonly used to quarantine and turn back unwanted immigrants.
Public-health nativism was also used to justify violence against immigrants. After a Chinese immigrant died of the bubonic plague in 1900, San Franciscans quarantined Chinatown and threatened to burn it down. Mayor James Phelan said that Chinese immigrants were “a constant menace to the public health.” Later, he ran for the Senate under a pledge to “Keep California White.”
More than a century later, the overt racism is gone but the underlying sentiment is the same. The ugly rhetoric we’ve seen over the past few weeks didn’t emerge out of thin air. In 2005, Lou Dobbs’s CNN show falsely reported that there had been 7,000 leprosy cases over the previous three years—one of immigration’s “deadly imports,” he said. The following year, Pat Buchanan claimed that “clearly the illegal aliens” were to blame for the rise in bedbug infestations. And so on.
Time and again, the public health opposition to immigration has been exposed as nothing more than a socially accepted form of xenophobia. That’s true again today. Ignoring the expertise of public-health officials, congressional Republicans and other conservatives continue to invent their own “facts” to prop up, once again, the idea that our country is pure and that foreigners who are trying to enter it are impure. The real disease here, though, is what Democratic Congressman Luis Guitterez called the right’s “demonization” of these desperate children.
By: Samuel Kleiner, a Fellow at the Yale Law and Information Society Project; The New Republic, July 15, 2014
“The Sanest Approach To Gun Policy”: The NRA Won’t Like This Idea
The National Rifle Association has just finished its annual meeting in Indianapolis. I don’t think I’m being reductionist in describing the NRA’s position on gun safety as pretty basic: Guns are good; gun regulations are bad. That’s unfortunate because the key insight in the perpetually fruitless gun control debate is that our social problem is deaths from guns, not the guns from themselves.
That distinction opens up the door to what I’ve always believed is the sanest approach to gun policy: a public health approach. What if we treated guns like cars, cribs and small electrical appliances? What if we focused less on the guns and more on when, where and why people get hurt or killed by them?
Automobile safety is an encouraging example. America’s roads are much, much safer than they were a half century ago. We didn’t become anti-car. We didn’t take cars away (except for some chronic drunk drivers). We made cars and roads safer and minimized the situations in which Americans were most likely to kill themselves on the road.
In 2010, the last year for which we have data, roughly 11,000 Americans died in gun homicides; 19,000 died by gun suicide; and 600 died from gun accidents – over 30,000 gun deaths a year. To put that in perspective, the faulty General Motors ignition switch at the heart of the current massive recall has been blamed for 13 deaths. Not 13,000. Not 130. Thirteen.
Experts believe that a high proportion of gun deaths are preventable. David Hemenway, a professor at the Harvard School of Public Health, has been an advocate of the public health approach to gun deaths for decades. I first met him when I was writing about this subject for The Economist in the late 1990s. The NRA annual meeting prompted me to call Professor Hemenway and ask what his top three reforms would be if our goal were to reduce unnecessary gun deaths.
Here are three sensible policy changes that would enable Americans to keep their guns and not die from them, too:
Universal background checks to keep guns out of the hands of criminals. Unlike drugs, just about every gun starts out legal. (You can make heroin in the remote regions of Afghanistan; you can’t make a handgun that way.) Regulations that make it harder for legal guns to end up in the hands of criminals and psychopaths will make it less likely that those criminals or psychopaths rob or shoot the rest of us.
More responsibility on the part of manufacturers for producing safer guns. The phrase “safer gun” may seem like an oxymoron; it’s not. There are many ways that gun technology can be improved to reduce inadvertent harm. Guns can be childproofed, so that young children cannot fire them. Guns can be equipped with “smart chips” so they cannot be fired by anyone but the owner. (This makes them both safer and less likely to be stolen.) Recording the unique ballistic fingerprint on every firearm would make it possible to trace any gun used in a crime back to its owner.
Lean on gun dealers to do much more to prevent “straw purchases,” in which a person buys a gun legally with the express intent of passing it on to someone who cannot buy a gun legally (e.g. a convicted felon). We do not consider it acceptable for retailers to sell liquor to people who are underage. So why is this practice in the gun trade not more rigorously opposed, including by gun enthusiasts? Let me connect the dots: If it is harder for bad people to get guns, then fewer bad people will have guns.
The NRA and the most steadfast gun rights advocates oppose these policy changes as well as the public health approach to reducing gun violence in general. Opponents typically subscribe to the “slippery slope” argument: If the government is allowed to require background checks or to promote “smart guns,” then soon all conventional guns will be banned.
This is sadly tragic logic. According to the New England Journal of Medicine, traffic fatalities per mile driven have fallen more than 80 percent since the 1950s. We’ve cracked down on deadly behaviors like drunk driving. We’ve used data to reduce other risk factors (such as young drivers driving at night or with other teens in the car). We put airbags in every new car and required seat belts.
Lots of people are alive today as a result. I may be one of them. When our Ford Explorer rolled over at 65 mph on an interstate highway in 2001, my wife and I were wearing seat belts and our two children were in car seats; we were relatively unhurt.
These kinds of changes are not costless. In the 1980s the major car companies argued that airbags were far too expensive to ever become a standard feature. Technology solved that problem; the same companies now use safety as a selling point. Most important, we have saved a lot of lives without fundamentally changing the driving experience.
So let’s do that for guns. The public health approach seems like an end run around a pro-gun versus anti-gun debate that is getting us nowhere. We have the potential to prevent tragedy – while still respecting the basic rights of responsible gun owners – if we focus on one crucial fact: guns and gun deaths are distinctly different things. I’ve never met anyone who is in favor of the latter.
By: Charles Wheelan, U. S. News and World Report, April 29, 2014
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