Ebola in the United States: Don’t forget the lessons we learned
Author: Maja Feldman
This article was originally published on KevinMd.com on October 27, 2014. It appears here with minor revisions.
140805 MEDEX EbolaUSA.jpg.CROP.promovar-mediumlargeAlthough I never disclosed this in my medical school interviews for fear of being just another cliche (“Hollywood sparks interest in medicine story”), I decided to become a doctor in 1997 at the age of 11 when I first saw the movie Outbreak. For years and years, this was my favorite movie. The scene where they showed the electron micrograph image of the Ebola virus had me captivated. I was staring at a ruthless serial killer. Disease was a subject I wanted to know everything about. My parents were both working at research labs in Fort Detrick, Maryland at the time (some scenes of the movie are set there), which made the film that much more engrossing. I became obsessed with bugs and viruses.
The closest I ever came to living the life of a virus hunter was the five years I spent as a program manager for Partners for Development, an international development organization. My job involved helping establish health and economic development projects for vulnerable populations. I frequently traveled to East and West Africa. With each trip I knew that I was taking a small, calculated risk. I spent time in and around hospitals, health centers and in very rural areas of Africa. Of course, my risk of getting malaria or TB was far greater than Marburg, Lassa or Ebola, but those were the exotic diseases I often thought about.
It was almost guaranteed that within a day or two of returning from my work trips I would be sick. Most of the time it was mild, nothing more than a combination of jet lag and traveller’s diarrhea. But I do recall one particularly long trip where I had spent time in East Africa, followed directly by a flight to Southeast Asia. I returned home with a fever and debilitating body aches. I self diagnosed as either having dengue fever or malaria. I went to my primary care doctor and explained how I felt. We Googled my symptoms together and he said he had never seen anyone with dengue, “But a friend of his had.”
In the end, it took almost two weeks to find a lab that could run malaria blood work. Two weeks later, long after my illness had resolved, I found out I simply had the flu. My story highlights that 1) the U.S. health system is extremely unfamiliar with tropical diseases; and, 2) the infrastructure to deal with them is there, yet hard to access without significant delays. This is not surprising. Only about 1,500 malaria cases are reported yearly. These figures fall sharply for the more worrisome viruses such as West Nile.
Had I gotten sick before I left Africa, I could have gotten a malaria test in less than 20 minutes. A single drop of blood. That’s because malaria killed 627,000 people last year, infecting 207 million, and most of those cases were in sub-Saharan Africa. It is a disease that in endemic areas is easily treated and recognized. Programs like the ones I worked on at PFD are providing crucial information and education to stop its spread. We like to think of malaria, dengue—insert any tropical exotic disease—as Third World problems. The recent events involving Ebola highlight how flawed that thinking is. In an increasingly global world, we can be halfway around the world in a matter of hours. Containment is harder than ever.
What does that mean to us? Should we ban all international flights, lock our doors and all start wearing N95 masks? No, of course not. We should realize that disease is of global concern and in an evolving world almost free of barriers our medical practitioners need quality education.
As a second-year medical student, I can tell you that I received 3 slides in a presentation related to Ebola, 1 sentence on Marburg, and 1 paragraph on West Nile. Our nurses and doctors are not being properly trained on how to protect themselves and how to treat patients. The best thing we can do in the future is knowledge sharing. Let’s break the lines industrialized countries have put up for themselves, and stop thinking of tropical disease as not “our” problem. We train our staff for earthquakes and natural disasters. Shouldn’t pandemics get the same? If policies are not clear, they should be. I have high hopes that, because of what we have seen, they will be.
That being said, please remember that 99 percent of the Ebola situation is happening in West Africa. The situation is poorly controlled, with grim predictions of up to 10,000 new cases a week. The best-case scenario for patients is dying without infecting others. This is a sad, very hard reality to face. The U.S. may have stumbled, but we will get back on track quickly — likely with few, if any, future infections. Liberia, Sierra Leone, and Guinea are facing an impossible task with limited supplies and support.
Given its method of transmission, in the U.S., Ebola will most likely stop with the couple of cases we already know off. But as the hysteria quiets and people return to their normal lives, let us not forget the lessons learned here.
Maja Feldman is a medical student. She continues to contribute to Partners for Development as a consultant.