An Ebola Epidemic Will Not Happen in the U.S.



USA Today features a slightly alarming headline: Ebola Only an Plane Ride Away from USA. Of course that is true, but that does presage the possibililty of a widespread epidemic here? No. Why not? Because my fellow Americans would go seek treatment when they feel ill and would submit to quarantine if diagnosed with the disease. Contrast this with how the New York Times reported some West Africans are sadly confusing correlation with causation:

Eight youths, some armed with slingshots and machetes, stood warily alongside a rutted dirt road at an opening in the high reeds, the path to the village of Kolo Bengou. The deadly Ebola virus is believed to have infected several people in the village, and the youths were blocking the path to prevent health workers from entering.

"We don't want any visitors," said their leader, Faya Iroundouno, 17, president of Kolo Bengou's youth league. "We don't want any contact with anyone." The others nodded in agreement and fiddled with their slingshots.

Singling out the international aid group Doctors Without Borders, Mr. Iroundouno continued, "Wherever those people have passed, the communities have been hit by illness."

Health workers here say they are now battling two enemies: the unprecedented Ebola epidemic, which has killed more than 660 people in four countries since it was first detected in March, and fear, which has produced growing hostility toward outside help. On Friday alone, health authorities in Guinea confirmed 14 new cases of the disease.

Workers and officials, blamed by panicked populations for spreading the virus, have been threatened with knives, stones and machetes, their vehicles sometimes surrounded by hostile mobs. Log barriers across narrow dirt roads block medical teams from reaching villages where the virus is suspected. Sick and dead villagers, cut off from help, are infecting others.

"This is very unusual, that we are not trusted," said Marc Poncin, the emergency coordinator in Guinea for Doctors Without Borders, the main group fighting the disease here. "We're not stopping the epidemic."

Efforts to monitor it are grinding to a halt because of "intimidation," he said. People appear to have more confidence in witch doctors.

Despite the scary headline, the USA Today article does note:

Yet while Ebola is a fearsome disease, the virus "would not pose a major public health risk" in the USA, [Michael] Osterholm, [director of the Center for Infectious Disease Research and Policy at the University of Minnesota] says.

That's because people need to be in intimate contact to spread the virus, Osterholm says.

Ebola is actually much harder to spread than respiratory infections, such as influenza or measles. Those viruses pose a much greater threat on a plane or in any confined space, says Osterholm, who notes that people cannot spread the Ebola virus simply by sneezing or coughing.

Ebola also can only be spread by people with active symptoms, [Stephan] Monroe, [deputy director of the CDC's national center for emerging and zoonotic infectious diseases] says.

"No Ebola cases have been reported in the United States and the likelihood of this outbreak spreading outside of West Africa is very low," says Monroe, who says that the CDC has sent 12 experts to Africa to help with the crisis. "While it's possible that someone could become infected with Ebola in Africa" before boarding a plane to the USA, "it's very unlikely that they would spread it to other passengers."

Ebola does spread readily through body fluids, such as blood and saliva, Osterholm says. On a plane, a sick person could potentially contaminate the bathroom if he or she vomits or has diarrhea…

Hospitals in the USA are on high alert for Ebola, however, and would quickly isolate anyone with suspicious symptoms who has recently returned from Africa, Osterholm says.

"Right now, we'd have to assume every case is an Ebola case," in people with suspicious symptoms, Osterholm says.

In a worst-case scenario, Osterholm says, a handful of emergency room workers could be exposed before a sick person is diagnosed.

That being said, if you've traveled to West Africa recently and begin to experience fever, muscle aches, chills, sore throat, vomiting and diarrhea, a rash and start bleeding all over the place—go see a doctor.

For more background, see my 2003 column, "Disease, Public Health, and Liberty," analyzing when quarantine is appropriate.