What Ebola outbreak would look like in U.S.
By Leo Hohmann
According to a senior health fellow at the Council on Foreign Relations, the world has no strategic plan to contain the worst Ebola outbreak in history while scientists are saying an outbreak on U.S. soil would require sweeping measures.
Total quarantine of cities or sections of infected cities and restrictions on air travel could be expected.
“We’re now in a perfect storm,” Laurie Garrett said in a CFR conference call Thursday in which she described the United Nations World Health Organization as “bankrupt” and drowning in debt. “There is no strategic plan for how this epidemic will be brought under control.”
The same term, “perfect storm,” was also used to describe the Ebola outbreak Thursday by the director of the U.S. Centers for Disease Control, Dr. Tom Frieden, in testimony before Congress.
If the statements are true, each nation must come up with its own plan to protect its people.
In the United States, that job falls to the CDC in Atlanta. As Frieden testified Thursday, the CDC raised its emergency operations center to Level 1, the highest possible alert in an effort to better coordinate a CDC-organized surge of health professionals and equipment being rushed to West Africa in an effort to contain the Ebola outbreak.
Nearly 900 people have died of Ebola in four west African countries since February.
Frieden also told Congress that it’s “inevitable” that someone with Ebola will get on a plane and fly to the United States, risking an outbreak here.
If, or when, Ebola does show up in the United States, the only way to combat the virus is through strict quarantines, said Dr. Arthur Robinson, a biochemist with Oregon-based Doctors for Disaster Preparedness.
“I don’t want to contribute to scaring everybody but at the same time, you’re dealing with total quarantine,” Robinson said. “You might have to quarantine entire small cities. Hopefully that doesn’t happen but it could.”
Robinson, who stresses that he has no inside knowledge of the government’s plans other than what he’s already seen play out, says he doubts the United States would be adequately prepared for a major outbreak of Ebola on its soil.
“I’ve spoken to people who are experts on African diseases and they are not very sanguine about CDC’s ability to deal with things like this,” Robinson said. “Their experience in dealing with bacterial warfare is almost zero, but that’s almost what you have here.
“We know almost nothing, this is a world we’ve barely scratched the surface in,” he continued. “We are probably not prepared. We have nothing that stops a virus other than quarantine and hoping it dies out. It has its own DNA, a code that is also able to penetrate a living cell. The virus takes over the living cell. The cell pops and then those viruses infect other cells. But by itself it is inert. It has the DNA but it does not have the machinery to reproduce itself without a living cell (as its host).”
Ebola is spread through contact with bodily fluids such as blood, sweat, vomit or feces. The symptoms include nausea, vomiting, high fever and diarrhea and there is no known cure. The death rate of the strain now infecting people is about 70 percent. The disease has up to a 21-day incubation period and the virus can live outside of an infected person’s body for hours, possibly days. As a viral hemorrhagic fever, it is one of nine diseases which the federal government has the authority to forcibly quarantine.
A living victim of Ebola “is alive with viruses and their cells are making more virus-infected cells at a tremendous rate,” Robinson said. “If you have contact with the bodily fluids of that person you’re getting a big dose. You get little tiny assaults with viruses all the time and your body is able to overcome them but once it’s in the body it’s a huge dose. People rubbing their eyes or putting their hands in their mouth, it breaks out. And a person infected is just a huge reservoir of the virus and cells that are supporting that virus.”
The very nature of a virus makes it hard to combat without a vaccine and Robinson pointed to the polio virus as an example.
“The thing that worries me is this is a virus and viruses are notoriously hard to combat, very difficult to beat because they are not alive most of the time,” said Robinson. “It does not live by itself, but it uses the living thing in which it is embedded to wake up and do its damage. There are viruses all over the place, we live in a sea of viruses, but when one wakes up you’re in a lot of trouble.”
According to a CDC statement released Wednesday, U.S. hospitals can safely manage patients with Ebola. “The key factors are isolation of patients, diligent environmental cleaning and disinfection, and protection of healthcare providers,” the statement said. “Providers in U.S. hospitals should wear gloves, fluid resistant/impermeable gown, and eye protection. In certain situations involving copious body fluids, additional equipment may be needed (for example, double gloving, disposable shoe coverings, and leg coverings).”
The CDC has 20 known quarantine stations throughout the U.S. but it is not known if those would be adequate to contain a full outbreak. A CDC press officer told WND she would have someone “get back with you” Thursday on this issue but no one from the agency followed up.
And other questions abound: Would there be enough testing sites, testing labs and hospitals capable of handling an outbreak? Screening stations would likely be set up at all international airports. For more details on how an Ebola outbreak might affect the United States, see this White House document drafted by the Clinton administration during a less severe Ebola scare in Africa.
The U.S. Department of Health and Human Services announced in July it was issuing $840 million to upgrade the emergency preparedness of state and local medical facilities.
But Dr. Jane Orient, M.D., a practicing physician in Tuscon, Arizona, and member of Doctors for Disaster Preparedness, wonders if it will be too little, too late.
“The fear is they would put people suspected of being infected, but who are actually healthy, in with people who do have the virus, so the threat is you would get it once you’re in quarantine (even if healthy to begin with),” Orient said.
She said the more sensible strategy would be to quarantine people in their homes.
“That is what was done with my grandfather’s generation, and then the family members can take their precautions and watch their symptoms,” Orient said.
She said recent articles about Obama’s executive order giving him authority to quarantine sick people and those suspected of being sick “is really nothing new.”
The U.S. has used governmental quarantine powers dating back to 1878.
“We always have to be worried about government overreacting and quarantining healthy people with sick people and people quarantining themselves and not going to work,” Orient said. “The situation is always going to be exacerbated if the population thinks their government is not telling them the truth, or is covering up.”
She said the vast majority of citizens living under the old Soviet Union believed in UFOs “and the reason they did was because the government said UFOs didn’t exist and the government must be lying like it always does. So the risk is that even if the government is telling the truth, for a change, the people just won’t believe it.”
Orient said there is no evidence the Ebola virus can be spread by airborne germs such as a sneeze, but nor is there any proof that it can’t, “so maybe we’ll find out late in the game.”
She said body fluids such as sweat or saliva could be found on any city surface.
“I don’t know (about Ebola) but some viruses can live for a couple weeks, and then the question arises, is it possible Ebola could develop air-born mutation,” Orient said. “So I would say, don’t panic, but people need to be aware this is a possibility. Unfortunately it starts off like a bad case of the flu.”
She said the CDC has put out communications that the disease can only be spread by direct contact with an infected person’s bodily fluids, “but that looks so contradictory to the way they transported these two patients to Atlanta, with extreme caution. When people in space suits are telling you ‘oh don’t worry, there’s no danger of this spreading,’ they have no credibility.”
Frieden, meanwhile, continues to try to tamp down any concerns. He exuded confidence that everything is under control in his latest press release, issued on Wednesday.
“The bottom line with Ebola is we know how to stop it: traditional public health. Find patients, isolate and care for them; find their contacts; educate people; and strictly follow infection control in hospitals. Do those things with meticulous care and Ebola goes away,” Frieden said in the release. “To keep America safe, health care workers should isolate and evaluate people who have returned from Guinea, Liberia, and Sierra Leone in the past 21 days and have fever or other symptoms suggestive of Ebola. We will save lives in West Africa and protect ourselves at home by stopping Ebola at the source.”
Robinson is less cheery about the CDC’s capabilities. He said there is no denying the fact that there are some cultural practices in west Africa that help the disease spread that are not present in American culture. That’s the good news.
“A person dies in Africa and the culture of poverty helps a disease like this spread because they don’t bury their dead right away, they don’t take certain precautions,” he said. “But if it appears in the U.S., if we get a couple of cases I think people would be looking for places to hide. These things are not trivial. We’ve just scratched the surface there’s so much we don’t know about these diseases.”