As I sit in an airplane heading toward New York City, a man in front of me coughs. Coincidentally, I am reading an article on CNN stating that there are now five documented cases of Ebola in Nigeria; one of them being a nurse who took care of that American citizen that died there of Ebola after taking care of his ill sister. They also report that a businessman died of a hemorrhagic fever that is very likely Ebola in Saudi Arabia after being in West Africa. There is no doubt in my mind now. Ebola has gone global. The man in front of me continues to cough.
I try not to be an alarmist; but I have a foreboding sense of immediacy. I completely believe in the ability of science to soon discover a vaccine to prevent the spread of Ebola and medication to treat it. But “soon” may be a year. In the meantime transcontinental transportation and mass transit may spread this virus like no one has ever witnessed before. The approximately 30 million people worldwide who have died of HIV may pale compared to the number that may die of Ebola.
I have spoken on CNN a few times recently about this epidemic. Perhaps it is my 25 years as a researcher of HIV and Hepatitis C and a frontline clinician that gives me some credibility…and pause. As a researcher I know that an answer WILL be found. I also know that even under the best circumstances it will take months to years to get treatments approved by the FDA. As a clinician, I know that if we wait any longer to enact strict preventative guidelines the thousand people who have died of Ebola could quickly become the tens of thousands or God forbid, the millions.
Therefore the time to set guidelines to prevent the spread of Ebola is now. Here are a few of my recommendations:
- Create a mass producible assay that is both specific and sensitive to diagnose Ebola. The luxury of waiting days to receive a lab result while quarantining a patient will soon be unrealistic. Hospitals will run out of appropriate isolation areas. Plus, with the impending cold and flu season, worried symptomatic patients will undoubtedly be rushing to their health care providers for diagnosis and treatment. There needs to be a quick method to diagnose Ebola vs. has viral enteritis.
- Give definite guidelines to physicians and nurses on how to properly handle a person with Ebola. The rate at which healthcare workers are contracting Ebola is infinitely higher then medical personal contract HIV or Hepatitis C from their patients. We don’t want doctors being vectors of this disease.
- Institute strict travel guidelines. In my opinion anyone who has a fever should not be allowed to board an airplane and eventually other forms of mass transit. A questionnaire is valuable only if the person is honest. Travel personal must receive preventative education and perhaps even special equipment (gloves, etc.) to protect themselves and others.
Alarmist? Perhaps, but let’s start the dialogue anyway shall we? This is as good a launching point as any. Remember, an ounce of prevention is worth a pound of cure. By the way, he is still coughing.