Ebola: Truth, Lies, Human Error, and Common Sense
With daily headlines featuring the world “Ebola,” fear is in the air. Along with confusion.
Many Americans are worried about Ebola spreading and becoming a serious threat. And many of us are skeptical about what the Obama administration is saying on the matter. Which leaves a lot of people feeling uncertain.
I’m one of those people and I set about trying to learn more about the virus and how it spreads, delving into areas where information has been lacking and/or has been conflicting. This is what I learned.
Many want to know if the virus can be transmitted through particles in the air. If it could, it would be a game-changer for a disease that is already spreading rapidly.
First, what exactly does “airborne” mean? Does it mean sharing the same air as an infected person and inhaling microscopic droplets containing the virus hanging in the air? Does it mean secretions spewed from an infected person traveling through the air and making contact with another person?
Technically speaking, airborne transmission is the former, not the latter. Per the CDC:
Unlike respiratory illnesses like measles or chickenpox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease. Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone, and saliva or mucus come into contact with that person’s eyes, nose or mouth, these fluids may transmit the disease.
Despite CDC references to coughing and sneezing, according to World Health Organization guidelines (as reported by CNN): "Common sense and observation tell us that spread of the virus via coughing or sneezing is rare, if it happens at all."
The CDC also states (in contradiction to other statements they put out on the matter) that coughing and sneezing are not common symptoms of the virus. That would be marginally reassuring, however since these symptoms are frequently cited in discussions about the virus with subject-matter experts, I find the mixed message confusing. In light of this contradiction, it seems prudent to err on the side of caution and assume it is possible that a person infected with Ebola might cough or sneeze and that this could put a person in close proximity to them at risk.
Offering additional insight on airborne transmission are four virologists writing for Virology Down Under. A central aspect of their discussion focuses on the size of the droplet from a cough or sneeze, conditions necessary for the virus to remain alive, and the nature of the exposure. The scientists argue that airborne transmission is not a characteristic of the virus and that recommendations for health care workers to wear eye protection and masks is less a sign the virus can be contracted via airborne transmission and more a reflection of the need for workers to protect the virus from reaching open membranes, such as their eyes. (The article is technical, but has a lot of valuable information.)
Further bolstering the view that the current form of Ebola cannot be spread via airborne transmission is a personal report from Jim Hoft of Gateway Pundit. Hoft, who just last year battled a life-threatening staph infection, writes:
UPDATE: I spoke with my cousin Dr. Dan Hoft M.D. Ph.D. an expert in infectious disease at St. Louis University Hospital. Dan is the Director of the new Division of Immunobiology. Dan helped save my life last year during my battle with a Strep infection that caused several strokes, put out an eye and damaged my heart. So, obviously, I trust him with my life.
Dr. Dan told me there has never been a documented case of airborne transmission of Ebola. However, he is concerned with the spread of this strain in West Africa. He will keep me updated if he hears more on this epidemic.
Expressing a less definitive view on the matter was Dr. Ronald Cherry, who wrote an article for American Thinker this summer citing several studies that suggest a strong possibility for airborne transmission. The article is illuminating, offers an excellent analysis, and contains numerous links to valuable research on the topic.
Whether or not one is convinced the current strain of Ebola can infect a person via airborne transmission, everyone should be concerned about the prospect of the virus mutating into a form that is transmittable via droplets in the air. And the more Ebola spreads, the greater the chances for such mutation. Elizabeth Cohen, CNN Senior Medical Correspondent reports:
…some of the nation's top infectious disease experts worry that this deadly virus could mutate and be transmitted just by a cough or a sneeze.
"It's the single greatest concern I've ever had in my 40-year public health career," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "I can't imagine anything in my career -- and this includes HIV -- that would be more devastating to the world than a respiratory transmissible Ebola virus." (snip)
Ebola is an RNA virus, which means every time it copies itself, it makes one or two mutations. Many of those mutations mean nothing, but some of them might be able to change the way the virus behaves inside the human body. (snip)
Dr. James Le Duc, the director of the Galveston National Laboratory at the University of Texas, said the problem is that no one is keeping track of the mutations happening across West Africa, so no one really knows what the virus has become. (snip)
"It's frightening to look at how much this virus mutated within just three weeks,"….
Mutation concerns are shared by the CDC. As Infowars reported in August:
A CDC advisory entitled Interim Guidance about Ebola Virus Infection for Airline Flight Crews, Cleaning Personnel, and Cargo Personnel reveals that the federal agency is concerned about airborne contamination.
The advisory urges airline staff to provide surgical masks to potential Ebola victims in order “to reduce the number of droplets expelled into the air by talking, sneezing, or coughing.” (emphasis mine).
The CDC is also directing airline cleaning personnel to, “not use compressed air, which might spread infectious material through the air.” (emphasis mine).
Talk about forest for the trees! The CDC zeroed in on cleaning protocols for airlines while law-makers refuse to block people from West African nations from coming to the United States. The CDC offered a small idea for a very big problem.
And how, pray tell, are “potential Ebola victims” identified? Airline staff are now tasked with making this determination? That’s absurd. I can just see the job description: Announce when the plane has arrived at the gate, check passenger ID before boarding, demonstrate proper use of seat belts, serve beverages, and screen passengers for a potentially life-threatening illness that even medical professionals admit is difficult to diagnose.
Meanwhile, the Chief of the UN Ebola mission has also expressed concern about mutations. The Telegraph reports:
There is a ‘nightmare’ chance that the Ebola virus could become airborne if the epidemic is not brought under control fast enough, the chief of the UN’s Ebola mission has warned.
Anthony Banbury, the Secretary General’s Special Representative, said that aid workers are racing against time to bring the epidemic under control, in case the Ebola virus mutates and becomes even harder to deal with.
“The longer it moves around in human hosts in the virulent melting pot that is West Africa, the more chances increase that it could mutate,” he told the Telegraph. “It is a nightmare scenario [that it could become airborne], and unlikely, but it can’t be ruled out.”
The likelihood of the virus mutating into one that can spread via airborne transmission has become a point of contention. Newsmax reports (bolding is mine):
“I don’t want to be an alarmist, but the possibility of Ebola becoming an airborne virus clearly has to be taken into account,” said David Sanders, associate professor of biological sciences at Purdue University.
"Ebola does share some of the characteristics of airborne viruses like influenza and we should not disregard the possibility of it evolving into something that could be transmitted in this way,” added Sanders….
U.S. health officials have largely dismissed Ebola as posing a major threat inside American borders.
Testifying before a Congressional subcommittee this week, Dr. Anthony Fauci, a top White House infectious disease advisor, said it was very unlikely Ebola would mutate in a way that would make it transmittable through the air like flu. (snip)
But Sanders disagrees. “I want the facts to be clear. It’s important that we not get the idea that this can’t happen,” he said, adding, “When people say that it is impossible for this virus to mutate, this is simply not true.” (snip)
“This is not how the Ebola virus is currently known to spread, but there is evidence that it has some of the necessary components for respiratory transmission,” he said. (snip)
“When people have looked at the current outbreak, the virus really hasn’t changed much,” Sanders said. “However, this research was done when there were 1,500 cases and now it’s up to 4,000 and if it gets to be 100,000 cases, there is more and more of a chance for mutations to occur.”
As noted in the excerpt above, there is a disturbing pattern of administration officials minimizing the risk to Americans -- an attitude that has become predictable on many fronts.
What makes more sense: Acting in a prudent manner and assuming this virus can infect others via airborne transmission or waiting until we have a full blown nightmare on our hands and have to play catch up? Given all of what we know, I think a child could figure out the answer.
In any case, airborne transmission aside, we are already playing catch up.
Countless reports state that healthy people can contract Ebola if they come in contact with bodily fluids of an infected person and if those fluids enter the healthy person’s body. But there appear to be some contradictions regarding the kinds of fluids in question. In particular: sweat.
On Sunday, Yahoo News published an AP report out of Dallas that stated the following (bolding is mine):
Ebola spreads through close contact with a symptomatic person's bodily fluids, such as blood, sweat, vomit, feces, urine, saliva or semen. Those fluids must have an entry point, like a cut or scrape or someone touching the nose, mouth or eyes with contaminated hands, or being splashed. The World Health Organization says blood, feces and vomit are the most infectious fluids, while the virus is found in saliva mostly once patients are severely ill. The whole live virus has never been culled from sweat.
The statement is contradictory. So I did further research.
According to the CDC: “Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola.”
CNN’s Sanjay Gupta states:
Blood, sweat, feces, vomit, semen and spit. Basically any kind of fluid that comes from the body. People in West Africa are avoiding hugs and handshakes because the virus can be spread through the sweat on someone's hand.
The uninfected person would have to have a break in the skin of their hand that would allow entry of the virus, CNN's Dr. Sanjay Gupta says. But "we all have minor breaks in our skin. And there is a possibility that some of the virus can be transmitted that way."
I don’t know about you, but I find transmission via sweat to be disturbing because sweat is a common fluid that leaks from our bodies, yet can be hard to see. There’s no acute event like vomiting or bleeding. Sweat just leaks from our pores. What happens if an infected person leaves a sweaty residue behind on the seat of a bus, for example? To answer that question, one has to know how long the virus lives outside the body. As you’ll see in the section below, it can live for a long time.
How long the virus lives outside the body
According to the CDC: “Ebola on dried on surfaces such as doorknobs and countertops can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature.”
Per the World Health Organization:
People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.
Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.
Echoing the last point in the excerpt above, Yahoo News reports: “The first patient to be diagnosed with Ebola in the United States died from the disease Wednesday and now Texas health officials are facing a situation they have not before experienced: how to handle a body that could remain highly contagious for several days.”
The article referenced in the paragraphs above includes a link to CDC guidelines for burying those who die from the Ebola virus. It is a detailed protocol that addresses post mortem as well as mortuary care, along with transportation of and disposition of remains. It is a sobering thing to read as one realizes the virus remains a threat even after it has killed its victim. The threat is so grave that the Independent notes: “Those who treat and bury the bodies of the dead, which are even more contagious than living Ebola patients, are especially at risk for infection.”
A virus that remains lethal long after the patient has died is a pretty disturbing disease to consider.
Health care workers and human error
There is speculation that the nurse in Dallas who tested positive for Ebola made a “breach in protocol.” If so, it would not be the first time such errors occurred, nor will it be the last. Infection control in hospital settings is a multi-step process that requires diligent attention to every detail of the safety protocol by 100% of health care workers, 100% of the time. As one might imagine, mistakes are made.
Consider something as basic as hand-washing. It’s a simple, life-saving standard of care. Yet it is commonly overlooked by doctors, nurses, and other health workers. As a result, they transport pathogens from one hospital room to the next, infecting patients as they go. In many cases, patients die as a result.
Now consider the many stages involved in suiting up before coming in contact with a patient with Ebola and the many steps involved in methodically removing all protective gear, including proper disposal, and you realize the opportunity for error is high.
The recent diagnosis of the nurse in Dallas who may have made such an error has been all over the news. Most recently, discussing the case on Fox News were Dr. Marc Siegel and Dr. David Samadi. The Right Scoop posted the contentious exchange. Siegel downplayed the risk, stating that Ebola is very difficult to contract, while expressing concerns about fueling panic.
Samadi was not arguing in favor of panic. He simply felt it was his professional responsibility to educate the public while sharing common sense ideas, with the driving force behind all policy decisions being the need to protect Americans. He made a perfect analogy when he said, “as a doctor I have to take care of my patients and families” and made the following, among many other, points:
- We are not prepared to deal with this disease. Emergency rooms, for example, are not ready. Nor are we prepared for a variety of scenarios such as what to do when someone with Ebola vomits in JFK airport. Who’s going to clean that up, and how?
- We don’t fully understand Ebola and there is no vaccine available.
- Until we are prepared, we need to “keep the wall up” by shutting down flights from West African nations.
- This nurse probably exposed other doctors other nurses. This shows the potential for how an epidemic begins.
- Fear and panic does not cause Ebola.
- Regarding Siegel’s perspective that we’re over-reacting based on a single case that made it into the country: “Everything starts with one case. Now we have two cases.”
I am grappling with the issue of the number of cases. On the one hand, the numbers are about as small as they get. On the other hand, infectious diseases spread exponentially. This is how you get from just a few cases, to a large population of infected individuals. Therefore it seems wise to err on the side of caution so we don’t wind up with an epidemic on our hands. Overall, Samadi made excellent points, none-the-least of which being the fact that we’re not prepared.
Betsy McCaughey, Senior Fellow at the London Institute for Policy Analysis, writing in the New York Post echoed Samadi’s concerns about our preparedness, or lack thereof. She also has concerns about Obama’s plan to spend $1,000,000,000 (yes, that’s billion) and send 3,000 troops to Liberia. The piece is so excellent it’s tempting to quote just about all of it here, but due to space limitations I will simply urge AT readers to read it. McCaughey, who is a staunch conservative, writes with incisive clarity.
- One commonly hears that transmission occurs via contact with bodily fluids from the infected person. At the same time, some statements say that such contact must be “frequent.” Per the World Health Organization as reported by CNN: “It's spread through frequent contact with bodily fluids and can be spread only by someone who is showing symptoms.” I’m not sure what to make of that other than to know that I would not count on infrequent contact as a safeguard against risk.
- Contact with surfaces that have infected particles on them also pose a risk. The World Health Organization reports: “Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.”
- And then there was the president telling people in West Africa they can’t catch Ebola sitting next to someone on a bus. Really? The why did the CDC advise Americans travelling to West Africa to "avoid public transportation?" And even if the CDC hadn’t made that statement, wouldn’t common sense tell you that you could, indeed, contract Ebola from an infected person sitting next to you on a bus should that person begin to spew bodily fluids your way? Not to mention if they left bodily fluids behind on the seat, such as sweat, and you came in contact with that biohazard waste in a way that would put you at risk.
It appears the Ebola virus in its current form is likely not spread via airborne route, though there is some controversy over this. There is, however, little question that as the virus continues to mutate it may become one that is transmitted via the air much the way a cold or flu virus spreads.
The virus lives for a long time outside of the body. Depending on the fluid it is living in, it can remain alive, and therefore contagious, for up seven weeks.
Obama tried to reassure people in West Africa, going so far as to say that no one should be concerned about catching Ebola sitting next to someone on the bus. In so doing he seemed eager to demystify any sense of stigma.
Well, there is stigma. And there are facts. Who’s to say the person sitting next to you on a bus is not infected with the virus? As noted in the prior section, if so, they could infect their seat mate.
So thanks for the advice, Mr. President. But as usual, it seems best to steer clear of your suggestions, ideas, recommendations, and proclamations. In fact, I would like to see you invite an Ebola patient with active virus to the White House where you can sit together on the couch and make small talk. Not unlike sitting next to someone on a bus.
No? You would rather not? Oh, I see. Good for thee but not for me.