Ebola In U.S.: Qualitatively DIfferent

The CDC has confirmed the first case of Ebola Virus Disease (EVD) to be detected in the United States.  Someone traveled from Liberia to Dallas, and, while in Texas, went to a hospital with symptoms of EVD.  Yes, this is worrisome.  Yes, this is a troubling, but expected, development.  It is not, however, cause for panic.  An Ebola case in the U.S. is qualitatively different than in West Africa.  Here’s why:1.  Ambulances.  Most EVD patients in Liberia are taken to the health care center in a taxi.  Quite often, these are over-loaded (four in the back, at least two in the front passenger seat), and are definitely not disinfected after transporting a patient.  One morning, going to work, the police had set up a road block and were making all taxis stop and open their trunks.  They may have been looking for sick patients.  Or drugs.  Both are very likely.  In any case, transportation can be a vector of infection here.  It will not be in the U.S.

2.  Hospitals.  We have them in the U.S., not so much here.  JFK, the “premiere hospital” in Liberia was built in the 1960s, and hasn’t been updated since.  It’s a lovely poured-concrete and cinderblock edifice.  It runs on generators, at least, the parts of it that have power.  There is very little equipment, and certainly none to constantly monitor a patient’s health status.  Infection control procedures were non-existent before the Ebola epidemic.  They’re better now, but not great.

3.  Doctors and nurses.  Liberia reportedly has about 50 doctors for the whole country (population: 4.5million, about).  Many hospitals in the U.S. have more doctors than that.  Also, these doctors are clustered in and around Monrovia, not in the leeward, so the more rural parts of the country have a severe lack of medical care.  There are more nurses, but not nearly enough, and their training is not nearly adequate to keep up with a disease like Ebola.

4.  Cultural practices.  First, Americans are more likely than not to follow what the public health officials say.  Sure, it’s not 100%, but enough that if the Surgeon General says “to keep from passing EVD, you need to self-quarantine if you have symptoms and call your local health care facility,” we’re likely to do so.  Here…not so much.  People distrust the government, see it as ineffective and incompetent.  The Health Minister made an announcement similar to that above, and people did not call, did not self-quarantine, and put each other at risk.  We also don’t have burial practices that involve hugging and kissing a corpse or washing the dead body and sprinkling the water on funeral attendees.

5.  General awareness of good health practices.  The U.S. population knows the basics of good health:  wash your hands, if you’re sick, stay home, don’t defecate or urinate in the street, and stay away from bodily fluids.  In Liberia, hand washing is now more common (buckets with bleach water are outside each building), so that’s good.  People who are sick still go out and mix with others.  There aren’t really toilet facilities in many homes, nor public latrines in many places so it’s a common site to see people urinating on the side of the road/public areas.  Just not really a risk in the U.S.

There are exit screening procedures at the airport to try and keep symptomatic people from boarding.  However, given the incubation period, that’s not going to be 100%.  The good news is that, in countries with even a slightly more developed health system, Ebola will not spread out of control.  Nigeria is a perfect example.  They had tens of cases, and that many only because one contact evaded tracing and developed symptoms later, infecting a second small cluster.  In the U.S., we caught it early, contact tracing is in effect, and it, in likelihood, won’t spread beyond a handful of cases.

St. Roch, pray for us.