Ebola in America: Not as devastating as it may seem

           syringe With a Gross Domestic Product per capita lower than that of Haiti and a healthcare program that spends an average of only $40 – $100 a year per person, the West African countries hit by the Ebola outbreak have been extremely ill prepared. Nearly 1800 people have been left to suffer with extreme headaches, fatigue, kidney dysfunction and excessive internal and external bleeding. Additionally, because there is no vaccine or curefor Ebola, around 60 percent of those that contract the virus die. However, even with all of these dangers in mind, health workers Nancy Writebol and Ken Brantly still chose to take the risky trip to West Africa to aid hundreds of strangers with their suffering. Through selflessly helping these patients, they have unfortunately contracted the deadly virus and have been sent back to the U.S. to undergo treatment. Bringing these heroes back to the states has generated a lot of buzz due to the infectious nature of the virus and fear that it may spread into our general population. This fear is understandable, but given all the precautions that will be taken to ensure the containment of the virus and given the selfless act that Writebol and Brantly committed, it is highly unlikely that the virus will be of any harm to us, but it is imperative that we provide them with the best medical care by bringing them back to America.

            Ebola is often depicted in the media as an uncontrollable virus, decimating countries in a matter of months. This causes many to overlook the actual facts regarding the disease. With a nearly exponential rise of infected patients in West Africa, we’ve become extremely concerned of Ebola’s highly contagious nature; however, transmission is not as simple as it may seem. According to the Center for Disease Control and Prevention, Ebola CANNOT be transmitted through air, food or water. Instead, it can only be transmitted through direct contact with an infected person’s bodily fluids (saliva, sweat, blood, urine and tears). Some health workers though, have become infected, but only through means as using improper cleaning techniques that spread infectious fluids around and by physically reaching out to patients without full protective gear to offer a comforting hand. These are isolated patients suffering from a deadly disease, so a comforting hand has the ability to effectively supplement medical treatment, but simultaneously puts our health workers at increasing risks for infection.

            The poor health care system in West Africa also contributes greatly to the alarmingly infection rates we are seeing. Doctor William Fischer, a member of the World Health Organization, who made a three-week trip to Guinea to aid in the Ebola crisis described the poor conditions patients and medical staff have to deal with. Although Dr. Fischer wore a full-body suit throughout his stay, this suit would reach temperatures of 115˚F in greater than 90% humidity weather. Along with limited medical staffing, he was required to work nearly 14-hour days, taking on the duties of both doctors and nurses. This type of environment is unheard of in America and promotes the occurrence of potentially deadly mistakes. Additionally, the isolation unit in Guinea designed to separate patients from each other, could not prevent wild chickens and rabbits from readily entering and exiting the facilities. This raises huge concerns regarding zoonotic (animal to human) transmission of the disease to uninfected groups of people.

            In comparison, the level of care provided to Writebol and Brantly at the Emory University Hospital is incomparable. Emory Hospital is special in that it is one of only four hospitals in the nation with a dedicated isolation unit for patients. This Serious Communicable Disease Unit was designed by the Center for Disease Control and Prevention to treat and isolate scientists that have traveled abroad and contracted potentially dangerous diseases. One cannot enter this unit without full protective gear and due to negative air pressure and other sanitation mechanisms in place, germs and other pathogens cannot leave the unit without first being filtered and rendered harmless. Also, according to Susan Grant, an RN and head nurse at Emory Hospital, she ensures us of the quality of the staff in that, “our education, research, dedication and focus on quality — essentially everything we do — is in preparation to handle these types of cases.” Furthermore, the CDC has a series of measures prepared in case Ebola escapes into the general population. This primarily involves quick diagnoses, isolation of patients and ensuring the medical staff in charge of caring for the patients remains vigilant in their disease control protocols.

            Another concern of bringing these patients back to America is Ebola’s high mortality rate (60%). This percentage is somewhat misleading as it is based on deaths occurring in countries with low levels of healthcare along with cultural beliefs and traditions, conducive to disease transmission. According to Dr. Fischer and his experiences of talking with West African patients, he believes that one of the biggest reasons for this high mortality rate is the late admission of patients to hospitals, partially due to distrust toward foreign doctors. Many of these families see their loved ones (sometimes very mildly symptomatic) enter hospitals, only to return “in a sealed body bag and robbed of their ability to say goodbye as their culture deems appropriate.” This leads to many families opting to care of their loved ones at home. Along with funeral bathing rituals and hugging of the deceased, these all amplify the transmission of Ebola between loved ones, through contact with bodily secretions that are released by infected patients throughout life and even after death. Furthermore, patients who are not immediately admitted to the hospitals, usually present with low blood pressure. Aggressive administering and regulation of bodily fluids (the preferred method of treatment) is no longer possible for these patients because by doing so, doctors put them at risk for shock and death. In the U.S. though, all these issues are easily avoided with the high quality of treatment that our hospitals provide and the proactive actions we are currently taking.

            Disease control has been a huge priority in America over the past years, yet the fears of an ensuing outbreak sometimes exaggerate the seriousness of Ebola compared to other deadlier diseases that we do not seem too concerned about. For example, the SARS outbreak in 2003 infected thousands more people than Ebola and can be transmitted through the air, yet SARS never generated the hysteria that is currently being seen. Additionally, strong efforts have been taken over the past years to decrease the incidence and mortality rates of malaria throughout the world, but according to the World Health Organization, this parasitic disease still kills an astounding 627,000 people every year. And although we have eradicated malaria from the U.S., there have still been 63 outbreaks of this parasite in the states between just 1957 and 2011. According to Dr. Tara Smith, the director at the University of Iowa’s Center for Emerging Infectious Diseases, there have also been many cases of Ebola-like diseases in America. Within the past decade, there have been seven cases of Lassa fever, a similar African hemorrhagic disease with a comparable mortality rate to Ebola and in 2008; a Colorado woman was diagnosed with Marburg virus, a virus in the same family as Ebola. ALL of these cases were successfully contained, without a single case of secondary infections.

            Many also fear that we still have no cure or vaccine for Ebola so if it does manage to get into our general population, the effects would be disastrous. One of the main reasons we are bringing Writebol and Brantly to Emory Hospital though, is to conduct high quality research on Ebola to further our understanding of the virus and to create a cure or vaccine in the future. Grant reaffirms that “Ebola won’t become a threat to the general public from their presence in [Emory Hospital], but the insight we gain by caring for them will prepare us to better treat emergent diseases that may confront the United States in the future.” To researchers, this is an excellent opportunity to learn more about the virus so that we can make contributions to a global issue facing numerous countries. We must remember, with the prevalence and ease of international travel, America is not isolated from the rest of the world and that proactively addressing the Ebola crisis is a wiser choice than trying to “shove the dirt under a carpet.”

            Beyond the practical dilemma of bringing Writebol and Brantly back to the states, we are avoiding a moral dilemma by doing so as well. Grant stated it well saying, “These Americans generously went to Africa on a humanitarian mission to help eradicate a disease that is especially deadly in countries without our health-care infrastructure. They deserve the same selflessness from us.” To deny them assistance would be analogous to leaving an injured soldier on the battlefield. Also, as a student applying to medical school, refusing care would raise enormous questions about the ethical foundation of our medical professionals who have vowed to always assist those in need. The moral issue behind bringing these two health workers back is similar to the question of if it is right to sacrifice one life to save many. In this case; however, the risk of harming the many is so miniscule due to Emory Hospital’s dedication to quality care and disease prevention that I believe we should save the two and by doing so, gain the research knowledge to save the many in the future.

            The thought of the Ebola virus ravaging our U.S. population is definitely scary, but when all aspects of this issue are considered, we should be able to see that we have much to gain and very little to lose by bringing Writebol and Brantly back to America. By doing so, we are able to save the lives of two extremely selfless individuals, further our research and make the morally justified choice. Many victims of Ebola spend their final days in isolation, suffering from a terrible disease that has taken the lives of their loved ones. We cannot allow the same fate to befall upon these two heroes that put their life on the line, in an attempt to save many more.

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