Wednesday, October 15, 2014

Ides Of October

It's been a fortnight since this blog officially crossed the decade threshold with an average of about 115 posts per year.  Right now, according to Google, my readership is majority American and Ukrainian, with a smattering of visitors from Europe and the Far East.  Thanks to all who read and cordially comment!

For all the panic-stricken press the Ebola patients in Texas have received, everyone here in the US should be grateful that there was but a single original case, and that the subsequent infections have been as quickly treated and as closely scrutinized as they are.  Frankly, a deliberate multi-point biohazardous threat agent attack by an enemy (such as that imagined by the late Tom Clancy in his 1997 novel Executive Orders) would have caught the US healthcare system with its knickers round its knees. The lack of clear nursing care protocols, the fact that the CDC initially instructed those potentially affected to "get in touch with a local healthcare provider" rather than setting up a national hotline to triage cases without risking further exposure of the general population (they may have done this by now--a person possibly leaking deadly viruses shouldn't be shunted to the nearest urgent care or emergency room!), and the now-public knowledge that there are only four civilian hospitals with appropriately isolated wards (I visited one when I was in the BTAEID program at Georgetown--it was tiny and pitiful, as was the cramped space on a nearby military base which had actually been used to quarantine the occasional bacteria-exposed researcher) in the entire country suitable to treat the sick is all evidence that despite some twenty years of public speculation, the US has done a poor job of preparing for the next potential pandemic.  The relatively slow and contained onset of this particular outbreak on American soil is a blessing--the disease can be monitored in a controlled environment, and whatever initial conditions led to the unfortunate nurses' infections can be avoided henceforth.

Back in the old days of slow land and sea-travel, countries could attempt to stop diseases at their borders through the use of quarantines. Often, quarantines were places where those who had escaped exposure at their origin point or en route could fall victim to various germs within hailing distance of their destinations, but this also was a relatively acceptable method of slowing transmission geographically.  At least among legal immigrants. Then, as now, illegal border-crossing was rampant.  Furthermore, fears about disease were often used to discriminate against particular ethnic groups.  I have read hysterical pleas for all human migration from West Africa to be curtailed, but not only is this impossible, it is impractical, and potentially cruel, as it condemns the healthy who are not trained to deal with biological contamination to continued contact with the sick.  Sending in American military supplies to the workers trying to treat the ill and stop further infections is one of the wiser decisions our government has made in a while.

AIDS has a 100% mortality rate. Ebola has a 50% rate.  Both are horrible odds, and neither is a comfortable way to die.  Thankfully, HIV can be slowed in its tracks thanks to various drug "cocktails", and mortality postponed for years for the infected.  Ebola has a much faster gestation, and so there is not the time for intervention that is available to most HIV positive patients. However, HIV can be spread among people who are asymptomatic, whereas Ebola has been found only transmissible when the virus has replicated sufficiently to cause symptoms.  The relatively short period between exposure and symptom-development for Ebola is thus also as much a blessing as a curse--past three weeks from exposure, there is no need to worry about having the illness.

Given that Americans are generally well-nourished and basically well-physicked (if not well-insured), I do not think an epidemic of anything besides paranoia is much likely here.  Poor Africa, on the other hand, is a continent long hostage to high HIV rates, and should the Ebola virus enter such unfortunate populations, the death toll could reach medieval European bubonic plague levels.  And given that worldwide travel in hours, rather than weeks or months, is normal these days, trying to shut down the outbreak in and around its point of origin is the best course, rather than waiting fearfully for it to spread internationally.  Would that deliberate human meanness were so easily addressed.

1 comment:

Barbara said...

Fascinating info/thoughts.