Over the last two months I have been privileged to undertake the first half of my internship for a Master of Public Health in epidemiology with the infection control team of a prominent hospital. As a result, my mind churns with data and practices regarding multi-drug-resistant organisms, hand hygiene, tuberculosis control, and surveillance for reportable diseases including HIV.
I have also been through at least a day’s worth of lectures and meetings on Ebola virus disease (or “EVD”, which I previously interpreted as “extra-ventricular drain” for cerebrospinal fluid diversion!), protective gear and waste management adaptations to safely care for EVD patients, and screening others for risk of exposure to Ebola virus.
If I never need to ponder the question “How can nurses keep up with over 10 litres of stool per patient per day?” again, I’ll be quite happy.
Given the emergence of Ebola in western and central Africa, along with the media hysterics over the African outbreaks and EVD patients who have come to North America, it’s been difficult for me to not view the current dilemma from a perspective informed by how Western societies reacted to the appearance of HIV among us in the early 1980s.
The major difference between the two series of events at the individual level is that ignorance is virtually indefensible today with most adults having access to global knowledge assets through mobile devices in their pockets. At the societal level, the 1980s were not plagued by multiple 24/7 news outlets baiting viewers with stories about a “crisis” or “emergency” and an abundance of “experts” eager for camera time to heighten the atmosphere of fear.
Instead of starting the hourly half-hour of Ebola coverage with disclaimers on exactly how Ebola virus is transmitted -- through direct contact of an uninfected person’s broken skin or mucous membranes with the blood, urine, vomit, feces, semen, breast milk, or sweat (rare) of a symptomatic infected person or medical equipment (needles) carrying the same -- cable news networks launch into nightmarish scenarios that overlook the success of modern public health systems (e.g. surveillance, contact tracing, quarantines, prompt treatment of infected persons, educating those at highest risk of being in contact with someone with active disease) in controlling infectious diseases.
It’s precisely those sorts of measures that helped stop previous smaller Ebola outbreaks dating back to 1976. The virus was successful this time in spreading simply because it emerged in areas with porous borders and ravaged by recent civil wars where public health assets had been decimated.
A 'historic' poster that hangs in a quiet hallway of the NIH Clinical Center. The poster advertised an educational forum for NIH nursing staff in 1983 regarding a new, obscure disease called "AIDS".
Amid the media-driven fear, it has been refreshing to see prominent figures from HIV research appear as voices of reason regarding EVD. National Institute of Allergy and Infectious Disease director Anthony Fauci appeared at The White House with other US government officials, declaring “We respect your concern. We understand your concern. But the evidence tells us that [a US outbreak] is not going to happen, and we have to say that a lot!” Across the Atlantic, Professor Peter Piot told the press, “An outbreak in Europe or North America would quickly be brought under control. I am more worried about the many people from India who work in trade or industry in west Africa. It would only take one of them to become infected, travel to India to visit relatives during the virus's incubation period, and then, once he becomes sick, go to a public hospital there. Doctors and nurses in India, too, often don't wear protective gloves. They would immediately become infected and spread the virus.”
In other words, beyond its areas of origin, Ebola virus may be destined to be akin to HIV as a disease of the under-resourced and underserved. Ingrained cultures of hygiene go virtually unscathed, while those without access to safe sanitation, medical “universal precautions,” and safe handling of the dead incur epic losses.