Several weeks ago a poll showed that 43 percent of Americans were "very worried" or "somewhat worried" that they or their immediate family member will catch Ebola. A doctor in New York being diagnosed with Ebola may have only exacerbated this "worry". So, I want to put the Ebola epidemic in America in perspective.
At present in America there have been four Ebola cases, hundreds of exposed individuals, and thousands of travelers from affected African countries. How do we deal with this and what should be our level of concern?
Among the four cases, our nation was dismayed by the death of the first patient, however the other three have recovered or in good condition in isolation units. Ebola usually causes death in 70 percent of the cases, but with early and aggressive treatment we have in America, I believe the mortality rate can be significantly reduced.
Hundreds of individuals have been exposed to these cases of Ebola. Even though their risk of developing Ebola is very low, local public health nurses are monitoring them.
Thousands of newly arrived travelers from Sierra Leone, Guinea and Liberia pose the greatest risk of developing Ebola. At any given time, 3,150 travelers are here from affected countries -- (calculated by assuming 150 daily arriving travelers who are at risk for 21 days). Nurses from local health departments are closely monitoring these individuals, and travel restrictions and/or quarantine are being imposed on them depending on their risk for Ebola.
It is important to know that travelers pose no risk of spreading Ebola infection at the time when they are not having symptoms. Hence the general population must not be concerned about contracting Ebola in public settings. What is reassuring is that many of the family contacts of the first patient Thomas Eric Duncan did not develop Ebola infection, emphasizing that Ebola is not transmitted by air or casual contact.
It may seem intuitive to ban flight from affected countries to reduce the risk of Ebola patients in America. Yet, at the present time, I believe it may paradoxically increase our risk. The borders among countries in Africa are porous and individuals will simply travel to another country and board a plane thereby spreading the virus within the African continent and to America. Also banning flights will severely restrict the travel of US health workers who are franticly trying to extinguish this epidemic in Africa.
The greatest challenge we face with Ebola in America is identifying potential cases. When travelers from West Africa present with symptoms at a hospital, a minor medical center or a doctor's office, it is critical to identity them at risk of Ebola and to place them in isolation immediately. This requires health providers asking a question like, "Have you travelled outside the country in the past 30 days" at every point of entry.
Another challenge is caring for the patient with potential Ebola infection. Donning and doffing the hazard-material "space suits" is not an easy task as I am learning during my training. Health care workers require practice, practice and more practice. The entire hospital staff need not be trained, only a designated team consisting of doctors, nurses and technicians. Locally, our goal will be to identify potential cases, manage them for 48 to 72 hours until the diagnosis is confirmed or rejected with the help of the health department and the Centers for Disease Control and Prevention. Subsequently, the patient can be transferred to one of the four national higher-level bio-containment units.
Although Ebola is a frightening virus, we need to keep it in perspective. The odds are extremely low that Americans will contract this terrible disease. Instead, what the general public needs to be concerned about at this time of the year is this: the flu. The flu usually causes 36,000 deaths each year many of which can be prevented by the flu vaccine.