I recently had the pleasure of listening to a live educational webcast of medical experts, sponsored by the New England Journal of Medicine, on what is known about Ebola transmission. I would like to share with you some of their conclusions and key points. If you have additional questions after you read this, I will be happy to answer them to the best of my ability.
Ebola is NOT a new disease. It has been studied for decades. What is new is its current dramatic spread internationally out of local communities in West Africa. This is thought to be occurring because of the societal transition from smaller local rural communities to much larger urban centers in West Africa.
Because of decades of study, experts know exactly how the virus is spread, and they have had decades of success containing Ebola and eradicating local epidemics. The challenge is applying these fundamental principles of epidemic control to larger urban areas and international communities.
Principle Number One: train healthcare workers how to put on and take off protective equipment and practice, practice, practice.
Principle Number Two: healthcare workers should have no exposed skin when working with patients.
Principle Number Three: a trained observer should be present when workers put on and take off protective equipment; there was absolutely nothing wrong with a supervisor NOT wearing protective covering on the airport tarmac when a patient was boarding a plane to travel to hospital as was recently covered and implied by the news media, because the supervisor was not in direct patient contact nor in contact with the patient's body fluids.
Principle Number Four: disinfect protective clothing and equipment of visible contamination before removing personal protective covering.
These four principles have stopped ALL past local epidemics of Ebola in Africa over past decades.
The reason this works is that Ebola is NOT airborne but is transmitted by direct contact with body fluids, NOT by cough or runny nose. What is meant by body fluids? The experts do not mean perspiration, runny nose or saliva. Body fluids are blood, vomit and diarrhea.
Ebola is very rare. It is not transmitted from drinking water or by exposure to urban sewage. A study from 2007 found virus ONLY where blood contaminated environmental surfaces. Virus was NOT found on surfaces without visible contamination such as blood, vomit or diarrhea. Much is known about Ebola transmission. If you wish to read more about it, go to cdc.gov/ebola.
Aerosolized contamination (blood, vomit, diarrhea) is NOT a significant form of transmission. A past study found NO transmission between sick and well monkeys kept caged at a close distance.
The risk to the public from a person incubating Ebola while he or she is well is NONE, whether that person is in a bowling alley or flying in an airplane or shopping in a grocery store or urban mall. This is a known fact and not speculation after decades of study of the Ebola virus in Africa’s recurrent local outbreaks.
The experts report that even in the initial early hours or first few days of an exposed person’s fever, the risk of transmission to others in the absence of vomiting, bleeding or diarrhea is Nil to none. Once an individual begins to vomit, have diarrhea or bleed, however, the risk of contamination and spread of virus directly from those body fluids is high. Isolation of the sick contact, providing that person health care by properly protected professionals, tracking of the sick person’s other contacts directly exposed to his/her body fluids and observing those contacts daily for 21 days (while they are well and are going about their normal daily routines) for the first evidence of illness is known to control and stop the spread of Ebola. This is fact, not speculation.
The mandatory confinement and isolation of people who are well, but have been directly exposed to the body fluid of people ill with Ebola is NOT necessary to stop Ebola. Tracking and daily monitoring of well people who had direct exposure to the body fluids of someone sick with Ebola, and then isolation of those people at the first sign of illness is what stops the spread of Ebola. Fact, not speculation.
In the first days of illness from Ebola without vomiting or diarrhea, there has NOT been transmission of Ebola observed in decades of study. Fact, not speculation.
There is NO transmission of Ebola from casual contact from well persons exposed to Ebola. The U.S. patients who were out in the community did NOT lead to secondary cases of Ebola. Family members and friends who were in contact with them were NOT infected. Limited data indicates that Ebola virus does NOT persist on environmental surfaces for long periods of time.
Consistent with all these facts is the observation that NO cases of Ebola have developed from the initial Dallas patient’s family members who lived in normal close family contact with him prior to his admission to the Texas hospital. Moreover, NO secondary cases of Ebola have occurred from normal family close contacts to the other Ebola U.S. patients prior to their hospitalizations.
Rational conclusions:
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Much is known about Ebola and how to control and stop its spread
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Stopping air travel of well persons to and from infected areas is not currently needed and in all probability would not be helpful.
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Well persons at risk of developing Ebola from direct exposure to an Ebola patient’s vomit, diarrhea or blood are not contagious when they are well AND are not contagious in the initial period of fever as long as they have not developed vomiting, diarrhea or bleeding.
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Well persons who have had direct exposure to an Ebola patient’s blood, vomit or diarrhea are at risk of developing Ebola for 21 days and do not need isolation when well. They only need daily monitoring for the onset of early symptoms of illness for 21 days. This does not require mandatory confinement.
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These persons in the first hours to days of becoming ill with fever are not contagious to the public or their families or their environment as long as they do not have vomiting, diarrhea or bleeding.
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These persons who present themselves to a hospital ER for care, observation, treatment and isolation when they first develop fever but before the onset of vomiting and diarrhea, present very little, if any risk to the general public or their families and friends.
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These persons, in the absence of vomiting , diarrhea or bleeding, are not contagious to anyone no matter where they have been before the onset of their symptoms.
Although the national news media are carrying daily updates and stories about Ebola which are disturbing and upsetting, the media are not sharing these known facts adequately with our public. If these facts were emphasized daily, public fear and panic would be at a minimum.
Recent Headline: “Cuomo and Christie Order Strict Ebola Quarantines
By MARC SANTORA
Gov. Andrew M. Cuomo of New York and Gov. Chris Christie of New Jersey said all people who had direct contact with Ebola patients in three West African nations would be quarantined.”
I hope you conclude from the information shared above, that this action by these officials is not rational, but caters to public fears and political pressures, instead of being a helpful response to Ebola control in the U.S. The mandatory confinement of healthy, well nurses and doctors who return from patient care in West Africa to secure facilities is not consistent with the science of Ebola transmission.
Let’s continue to watch the news to see if science and evidence inform the judgements of politicians and lawmakers. We all will be safer it this happens.
Dr. T
10/25/14