Every infectious disease nurse and medical practitioner understands the first rule of outbreak containment is isolation and quarantine. Ebola is a lethal virus decimating the populations of the West Africa countries Liberia and Sierra Leone but neighbouring nations such as Senegal and Nigeria remain free of the scourge. The explanation is quite straightforward. These countries have closed their borders effectively isolating the region from further contamination. There are two reasons this virus is particularly deadly. It affects an impoverished rural population with little understanding of basic Western concepts of personal hygiene including facilities for proper washing and sanitation disposal. The afflicted die primarily with horrendously painful distress as the digestive system inflames causing incapacitating dehydration and bleeding. In the absence of even basic health facility infrastructure, the patients are doomed. Treatment consists of early and aggressive intravenous therapy modalities largely unavailable in the remote areas where this affliction began. In North America, we concern ourselves with sneeze and cough contacts with flu viruses– all controllable with the simplest hand and oral hygiene. In West Africa, there aren’t the disposal facilities to manage the contaminated digestive tract wastes resulting in whole villages becoming affected.
On this side of the ocean, one affected man, ONE, lied his way in to the United States and subsequently died of Ebola but not before contaminating two attending health workers. Competing cable news outlets repeatedly broadcast the inept responses from the Center for Disease Control. By my count, they have now issued five separate somewhat contradictory guidelines and what should have been a managed health issue became a midterm election football exemplifying the President’s lack of leadership followed by individual state governments creating their own isolation protocols and/or “voluntary” quarantine. Now we have an American nurse pedaling around Maine with a Court injunction decision saying the quarantine violated her civil rights; and a returning aid doctor in New York riding the subway, bowling and dining out before relenting and entering hospital with Ebola. U.S. miltary personnel are being sent to Africa and they have already been told there will be a mandatory 21 day quarantine when they return but no such restrictions apply in the private sector.
There are three aspects of this manufactured crisis that have not yet received much public scrutiny. The dollar cost of treating this one Dallas patient and all the airplane, restaurant, public transit and family/personal contacts has not been revealed. So far, the limited exposure has been more luck than skill. Its true, the mom and newborn sitting in the next seat on the plane were statistically very unlikely to acquire Ebola from a cough or sneeze. The CDC used the word improbable but did not say impossible. More likely an Ebola patient becoming unwell with an acute digestive event on an eight hour flight from Europe necessitating use of the confining washroom facilities with another 300 passengers would be the contamination source. Those 300 land in New York, then where do they go? Worst case scenario? Some terrorist group bent on martyrdom self contaminates with the virus before riding the public transit system of a major city. We need to address this situation from a different perspective. Yes, send our most competent volunteer health professionals to the source and compensate them for the inconvenience of a mandatory three week quarantine before they return. Keep the problem isolated in West Africa with a total travel ban including issuing no visas. It’s time to return our focus to the prevention of the thousands of deaths here annually from superinfections– hospital acquired and other. And let us not forget the thousand seniors for whom this winter’s influenza will be the terminal event. The first priority of government must be to protect its own citizens.
Dr. David Carll