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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Perspective: Ebola in the U.S. Dare we say the tide is turning?

March 18th, 2015

The first U.S. Ebola patient was in a sense a call unheeded, like the knocking at the gate in Macbeth, startling us so from our sin of unpreparedness that we dared not answer lest we be exposed. Then two days later it came again, insistent with suffering, a boiling virus from the continent where the residue of all human DNA resides.

We have now answered and been found wanting, with two nurses infected and the index case lost. Cue panic and irrational fear. People that have even visited Dallas, miles from the hospital involved, are told not to return to work. Incinerated waste, burned beyond viral recognition, is not allowed to cross state lines to a landfill. People in hazmat suits at airports? It’s hard to tell if they’re making a statement or are just really, really erring on the side of caution.

Health care workers who actually care for Ebola patients are at risk, but this vision of a zombie apocalypse in the community is absurd. Remember in this U.S. outbreak, the people actually diagnosed or infected in this country -- after all this hue and cry -- is now at a grand total of four. Two of those were infected in Africa and became symptomatic after entering the U.S. The only two people who were actually infected in the U.S. are the aforementioned two nurses. Bottom line: Right now you have a greater chance of being struck by lightning and then run over by a golf cart than acquiring Ebola in a U.S. community.

I think the CDC ramped up the fear factor a while back with projections of cases in Africa hitting 550,000 to 1.4 million -- based on old data and thus already obsolete -- to stir the rest of the world into action and secure the funding they need from our government. This is their standard MO in these situations, give us a shot of fear if we get too complacent, reassure everyone if panic starts to set in. To be frank, they underestimated Ebola and overestimated hospital preparedness. But they’re playing a hell of a catchup game. At the risk of jinxing them, I think the tide is turning. There have been no secondary cases among index patient Thomas Duncan’s community contacts, no infections of other health care workers at the Texas hospital, nor in any of the people who were on the plane with the second nurse who acquired Ebola.

All that could change of course. Ebola is not invincible but it is completely unforgiving. Some people in the aforementioned groups are still in the 21-day incubation period, but with each passing, infection-free day that possibility is becoming less likely. The majority of Ebola infections appear by eight to 10 days after exposure. We are right at that time frame with some 130 passengers on an Oct 13 Frontier Airlines flight that carried the second nurse home to Dallas, reportedly with a 99.5 degree fever. In the exceedingly unlikely event that a passenger on that flight acquires Ebola, the conspiracy theorists will have their first case of literal airborne transmission. It’s not going to happen.

The key remains stopping Ebola in West Africa. Until then we can expect sporadic cases here, but the virus is not going to get very far because contact tracing will be done on all potential exposures. The CDC turned the screws a little tighter Wednesday with the announcement that on Monday Oct. 27 they will begin active monitoring in major airports in the six states where approximately 70% of incoming travelers from the outbreak region arrive: New York, Pennsylvania, Virginia, Georgia, Maryland, and New Jersey. That means twice-a-day temperatures for three weeks even if these travelers report no Ebola contacts and have no symptoms. Expect the net to widen to include more of the remaining 30% coming in to other states, as the aggressive actions being taken by the CDC will finally -- if I dare repeat Director Tom Frieden’s ambitious early prediction – “stop Ebola in its tracks.”