Eight of the top 12 urban legends on Snopes.com, a myth-busting website, are about the Ebola virus – including one about a Texas town that had to be quarantined. Panic surrounds Ebola and it can spread on the Internet even faster than the virus.
“The balance between good information and information that causes people to panic is very difficult to achieve,” said Dr. Jose Cadena, an assistant professor of medicine and infectious disease at University of Texas Health Sciences Center (UTHSC), and the medical director for infection control and hospital epidemiology at the South Texas Veterans Health Care System. He joined a panel of six local infectious disease health professionals with similarly impressive credentials at Wednesday night’s standing room-only forum on Ebola at the University of the Incarnate Word.
The overall atmosphere of reason and careful concern prevailed throughout the evening and may have soothed some fears, but was unlikely to dispel all concerns and myths about Ebola.
The panel discussion was moderated by UIW Professor of Biology Ana Vallor, in the UIW School of Nursing’s auditorium. Every seat was taken, mostly by affiliated students, faculty, and healthcare professionals, along with community members.
The audience peppered panelists with a steady stream of questions until time ran out, and panelists took their time providing details — often hopping in, two and three per answer.
The original U.S. patient in Dallas, Thomas Eric Duncan, died on Oct. 8. Two of the nurses who treated him when during his hospitalization have contracted Ebola and are undergoing treatment or have recovered, and there have been no further transmissions to date.
There is good news, said Anil T. Mangla, Ph.D., assistant director of the communicable diseases division at the City’s Metropolitan Health District. There have been no "community transmissions” in the United States from Duncan to others, such as his friends and family members. The only transmission was to health care workers, which became more likely during the late stages of Duncan’s illness when he was most infectious.
“If you (walk) by a patient on the street who has Ebola, you’re not going to get Ebola,” Cadena said. “What we deal with in the hospital is much more close contact than what happens in the community.”
The current epidemic started in Africa in December 2013, said Cadena, although “it took almost a year to go in and try to stop it at the source.” Cadena referred to Duncan's case as “a call to attention” to the epidemic oversees.
“(But) if people are fearful about this disease, they really should not be,” said public health specialist Mangla. “Because we have the capabilities to contain it, and contain it very quickly.”
Mangla explained the difference between “infectivity,” also known as “infectiousness,” and “contagiousness.” Ebola is quite infectious, but without being particularly contagious. Contagion is measured in R Nought values, a measurement of how many people the typical victim is liable to pass the disease on to. For Ebola, the panelist described an R Nought value of two to four — meaning, “if someone is sick with this virus, they could spread it to between two and four people,” said Mangla. The R Nought value for mumps or measles, both highly contagious, is more like 16-18.
Technically, San Antonio already “has” Ebola. For 10 years, the lab at Texas Biomedical Research Institute (TBRI) has been studying the virus.
“2004 is when we started working on it in our laboratory,” said Ricardo Carrion, Jr., Ph.D., an associate scientist and laboratory scientific manager at TBRI.
Ebola was discovered in 1976. An interesting article in the British press, published earlier this month, describes what we’ve known and for how long about Ebola.
Mangla described the system in place in San Antonio, where “gatekeepers” in hospitals and 911 dispatch services can ask two crucial questions about recent travel to West Africa and symptoms. The answers to these questions can set into motion an alert that goes out from the public health department to prepare EMS and hospital workers for a suspect case. One thing that wasn’t clear was how that would account for victims who lied about their exposure, as it’s believed Duncan had initially done.
"When we do things right in public health – for years and years – nobody knows about it. But one misstep, no matter how small, and (it’s like) the world is crashing down," said UIW Adjunct Biology Professor and epidemiology consultant Cherise Rohr-Allegrini, Ph.D..
Public health professionals in San Antonio have been preventing outbreaks of diseases other than Ebola, like mumps, measles and tuberculosis, “and they’ve been doing it for years and years,” she said.
Rohr-Allegrini has been working with a major local health care system on the Centers for Disease Control and Prevention’s (CDC) evolving infectious disease guidelines as well as Emory University in Atlanta, where several earlier American patients had returned for treatment after serving on a missionary medical team in Africa. Rohr-Allegrini said Emory’s set of guidelines include 84 pages of protocols. She cites local hospital systems and their prior pandemic flu training as evidence that they’re prepared to deal with Ebola, too.
Several panelists expressed amazement that despite the initial U.S. patient being cooped up in a small apartment in Dallas for days with family members when he was first symptomatic – including with piles of hazardous biomedical waste that were accumulating during his stay – none of the family members have apparently gotten sick. Given that hospital workers were infected, panelists suggested lessons learned included more careful use of protective gear and stricter protocols.
“That experience in Dallas was (unfortunately) very costly to Mr. Duncan,” said Dr. John R. Graybill, board-certified infectious disease specialist, and professor emeritus at UTHSC's infectious disease division. “But it’s been phenomenally valuable to the rest of us."
Graybill blamed elements of the mass media for sensationalizing the coverage over Ebola and suggested that it can be driven more “by ideology than by evidence.”
Graybill said we have “fiscal conservatives in this room, and beyond” to thank for a lack of Ebola vaccine because of an underfunded National Institutes of Health. “I bet it’s a lot easier getting money for research right now than it was a year ago.”
*Featured/top image: The Ebola virus. Image courtesy of the CDC.