Friday, 14 November 2014

The Truth About Ebola. To Quarantine or not to Quarantine!

Ebola is ravaging West Africa killing over 5,000 as of the time of this posting. Even trained nurses in the US and Spain, who have better knowledge of the Ebola disease contracted it. You may ask: "How can we be anything but afraid of this epidemic?"

You may recall the situation with Kaci Hickox who returned from West Africa, after treating patients with Ebola. She defied the mandatory quarantine imposed on her by the State. Many health experts explained that she wouldn't be a risk to the public, but many people still considered her actions as selfish and irresponsible.

The sad part is that people don't fully understand how Ebola works and instead make incorrect judgments. I listed some FAQ's that I hope can help shed some light on your concerns. I want to add that I am not a Health Care Worker (HCW), but you don't need to be one to know what Ebola is and learn how to prevent it.

1) Is Ebola very contagious?

No. Ebola is spread through direct contact with bodily fluids such as blood, vomit, urine or sweat. By direct contact, I mean that infected fluids must enter your body through the mouth, nose, eyes, cuts or wounds. So if you're beside someone who has Ebola, it's very difficult for you to contract the disease as long as you don't have direct contact with his or her bodily fluids.

To put this into perspective, Fanta Condé, the little girl from Mali who contracted Ebola and died later from it didn't infect anyone who was in contact with her. This includes her grandmother, sister and uncle.

2) If it's not so contagious, why is it spreading like fire in West Africa?

West Africa has for a very long time suffered from poverty and lack of education. For a while, many thought that the disease is a hoax and even attacked an Ebola treatment center! They also have several customs that increase the chance of infection, such as touching deceased people to say final good byes.

But the main reason is the lack of robust health systems. Families are often forced to transport their sick ones to hospitals and treatment centers. Sometimes they are forced to care for the sick ones at home when there aren't enough beds. They end up cleaning up or removing Ebola-infected fluids by themselves which puts them in great danger. In developed countries, all that is needed is for someone to call 911 and indicate the possibility of exposure to Ebola. They will take care of transportation and disinfecting infected areas.

Q3. How can you explain why US nurses contracted the disease, even with the use of protective gear?

It's true that nurses have more knowledge about Ebola and received training on how to care for Ebola patients. However, Health Care workers have continuous contact with bodily fluids contaminated with Ebola which makes them more at risk that the average person. These HCW's are undoubtedly heroes because they put their lives at risk. It takes only a small mistake for someone to get infected. As of November 14, at least 6% of those who died were HCW's (324 HCW's).

Q4. Why doesn't the WHO recommend mandatory isolation or quarantine for HCW's returning from Ebola infected countries?

Let's look at Kaci Hickox case. When she returned from West Africa, she was tested negative twice from the disease and was showing no symptoms. The governor still wanted to impose a mandatory 21 day quarantine out of fear that the virus may be in its incubation period (2-21 days), and could become contagious later.

While the governor's request seems reasonable, it's not scientific. There's no need to quarantine or isolate someone at this stage. That's because they are not contagious. The individuals must instead go through active or direct monitoring by checking for fever twice daily for a 21 day period. Active or direct monitoring is different than "self-monitoring" as it requires someone to take the temperature and get a symptom story. Until symptoms such as fever, diarrhea, vomiting or bleeding appear, the individual will not be contagious. There's no need to fear working with someone returning from Liberia, or be afraid of attending school with a colleague returning from Sierra Leone. It's unfortunate that Canada imposed a visa ban, which WHO disapproved of, on residents and nationals of Ebola-affected countries. I reiterate that they pose no risk as long as they don't show symptoms.

Q5. How can I feel safe if they can "all of a sudden" show symptoms and infect others?

I actually heard this concern from a few people who didn't feel that monitoring temperature twice daily is good enough because they are afraid that someone can become contagious sometime midday. Again, this is not scientific. Ebola's symptoms have a life cycle, and they initially start as fever, fatigue and muscle pain. The chance of contracting Ebola in that early stage is basically zero, according to the head of the National Institute of Allergy and Infectious Diseases (NIAID).

Q6. Ebola's fatality rate is 90% and there is no cure or vaccine. Doesn't it make sense to implement a quarantine for HCW's to avoid risk of death?

Ebola's fatality rate averages around 50% and ranges from 25% to 90%. These rates represent the fatality rates in West African countries where there are very poor health systems and lack of education as mentioned previously. The fatality rate in developed countries such as the US and Spain is low and all patients have now been released from hospital. This reinforces the importance of early detection and the need of a robust health system. I am not claiming that Ebola is not dangerous, but it's not as dangerous as you might think it to be.

In fact, this is why imposing mandatory quarantines for asymptomatic HCW's is actually irresponsible and will be more detrimental than beneficial. It will undoubtedly deter HCW's from volunteering to fight the disease and prevent it from spreading. Imagine what happens if this disease spreads to other African countries, India or the middle east. The worse it gets, the more difficult it will be for us to stop it. We must do whatever we can to encourage HCW's rather than discourage them.

Q7. What if Ebola becomes airborne?

It's extremely unlikely for this to happen. The possibility of Ebola virus mutating and becoming airborne is significantly less than the possibility of the AIDS virus becoming airborne which has been mutating in carriers for more than 30 years and yet hasn't become airborne. Ebola on the other hand often kills its carrier before it can mutate enough. The only reason that there is so much fear of such scenario occurring is because of the popular movie Outbreak.

I don't suggest in this article that people should be complacent and downplay the risk of Ebola. Ebola is dangerous and deadly. Nevertheless, the best way to react to this threat is to understand it first and be ready should it come knocking on our doors. We should also be mindful of those who are close to the outbreak who are being stigmatized. There's no need for an outcry when students return from Uganda or to deny accommodation for a student from Sierra Leone. We can still protect ourselves while being smart at the same time.