Besides Thomas Eric Duncan, the Liberian man who died after being diagnosed with Ebola while in the United States, all of the other U.S. patients have survived. The latest patient, Dr. Craig Spencer, has not been declared Ebola-free, but his condition is improving.
Healthline sat down with Dr. Lee Norman, who is not only chief medical officer at the University of Kansas Hospital, but also a U.S. Army officer serving in the National Guard, and an advisor to Homeland Security and regional disaster preparedness agencies.
Should the American public be scared about Ebola?
Norman: The public response has been accentuated beyond reason. It’s serious if a person gets Ebola, but in our country we will not be seeing the same kind of outbreak they are seeing in Africa.
The fabric of those countries is so much different. They don’t have law and order, a police force, good vigorous public health departments, hospitals, and sufficient caregivers. People don’t have equipment. The response overall has been slow getting the necessary things there because it is so dangerous there now. We have such deep and capable services available in our country to contain this outbreak. I don’t think it is going to get the same kind of footprint here. We’ll see sporadic cases because of travelers, for the most part.
We have great facilities, supplies, and a talented workforce that is committed to infection control practices. We have a safe place to receive care, where you are not awash in Ebola virus. Think about a nor’easter, with rain pelting down and wind blowing rain sideways; that’s what it’s like in West Africa. Imagine putting on shabby, inadequate protective equipment and going out in a rainstorm. What's the likelihood that you are going to get some rain underneath shabby protective equipment versus if you are going to put on high grade Personal Protective Equipment (PPE) and go out into a slight misting rain? You will be dry underneath.
We need to keep our guard up and an abundance of caution to really engage our staff, have the best quality protective equipment, and then adherence to the standards that are considered state-of-the-art infection control practices.
Should the public be alarmed that two healthcare workers who treated Thomas Eric Duncan contracted the disease at Texas Health Presbyterian Hospital?
Norman: It is a little bit alarming to have the situation in Dallas, with two healthcare workers becoming infected. It’s a reminder that, one, we don’t know everything about this disease; and two, the recommendations will be changing as time goes on in terms of the protective equipment and practices that we do. But we get smarter by the week.
It’s also “telling” that of the eight cases we’ve had in the United States, seven patients have survived. Compare that to Africa where there is a 70 percent death rate. Certainly one death out of eight in the United States is a marked difference. It’s a testimony to the fact that early treatment will prevent, in most cases, people going to latter stages of the disease. If you are in the first third, or the second third, of the illness, even with aggressive fluid electrolyte management, people won’t have the same degree of organ death or organ dysfunction that leads to the third phase of the illness and death.
The public needs to put it in perspective when they think about all the other scourges people die of in our country — 22,000 unimmunized people die of influenza, 32,000 motor vehicle accidents, and hundreds of thousands of smoking-related deaths. The fact we’ve had one death from Ebola pales by comparison. Even in Africa, Ebola is not in the top 20 causes of death; it’s way down the list.
There has been fear and outrage that Dr. Craig Spencer, the doctor in New York recently diagnosed with Ebola, traveled on several New York subway lines, dined at a restaurant, and went bowling prior to his diagnosis. Is this fear and criticism justified?
Norman: All we can do is try to educate and sympathize with people’s fears, but at the same time try to correct their misconceptions. One of the things we do know: A person who is incubating Ebola, but hasn’t become symptomatic, is not thought to be infectious. For a person to catch Ebola, they have to touch the secretions or body fluids from someone who is in the symptomatic stages of the disease.
It’s unlikely, bordering on zero percent likelihood, that a person who is not symptomatic from Ebola infection will transmit the virus. There isn’t any good reason to believe the physician in New York was symptomatic, certainly not having diarrhea, vomiting, or bleeding from bodily orifices, so there is no reason to believe he was infectious [before he submitted himself for treatment].
This past weekend the governors of New York and New Jersey imposed mandatory quarantines for healthcare workers returning from West Africa. They later loosened those regulations to allow home quarantines, following fallout from nurse Kaci Hickox, who was forced to undergo quarantine in what she said were inhumane conditions. Should healthcare workers who return from West Africa be quarantined?
Norman: There are a couple of problems with quarantine, isolation, or restricted movement. People coming from overseas who have been in those affected areas are not going to be honest with public health and other officials if they know they will be quarantined.
Quarantine is going to drive people underground. We’d rather have people feel comfortable self-identifying. A lot of the quarantining being discussed around the country is unnecessary. If we have sporadic cases around the country, and let’s say a person does have Ebola, and you have to take every person who has seen that patient out of action for 21 days, that could be as many as 60 or 70 doctors or nurses who have to be quarantined at home without any symptoms at all; they can’t see any patients. That is a terrific burden on the health system.
How will the upcoming Thanksgiving and Christmas holidays impact Ebola transmission during America’s busiest travel season?
Norman: A broad, sweeping policy about quarantine or travel restrictions isn’t really practical. People have to ask the right questions: have you been to West Africa, have you cared for Ebola patients, have you had contact with somebody who has had Ebola themselves or has traveled? There are not many people at any given moment in time who have that history. If they don’t have that history, they don’t have Ebola.
Especially coming into the infectious disease time of year, there will be a lot of people with fevers, and essentially zero will have Ebola. People will have upper respiratory infections, bronchitis, and influenza.
Are you concerned about the first diagnosed case of Ebola in Mali?
Norman: We will beat this into submission until we get to the point where we won’t have Ebola in the United States, but it won’t be until the outbreak in Africa gets subdued. The case of a young child who died recently in Mali is worrisome. Mali shares its border with Guinea. The child, who came across the border in a bus, bleeding and quite ill, died of Ebola. People on that bus were in close proximity to this baby, who was obviously symptomatic. Mali isn’t like Senegal or Nigeria. It is similar to the other three nations (Liberia, Guinea, and Sierra Leone), so it could get a toehold there.
Photo courtesy of Dr. Lee Norman.