Living (and dying) with Ebola

I think it was someone on Facebook who commented that the rising panic in the United States and other Western countries over the possibility of an “imported” Ebola outbreak within their borders is “quite apt” for countries that exported diseases like measles, small pox and tuberculosis—not to mention sexually transmitted infections—to developing countries during the Age of Conquest.

Historians say the demise of great empires in Central and South America like those of the Incas and the Aztecs was due as much to natural causes, such as the spread of diseases against which the natives had no immunity or protection, as to internal strife and superior European arms.

Scientists agree that Ebola is a “homegrown” disease originating in Africa, most probably crossing species as Africans succumbed to the lure of “bush meat,” the flesh of wild, undomesticated animals (a prime suspect is the fruit bat) inadequately prepared, through which the deadly virus could jump from animal to human.

I seem to remember during an earlier Ebola outbreak the reassurances of doctors that there was little chance of the disease crossing borders because its victims died shortly after infection, limiting the possibility of spreading out to a larger population. So what has changed since, and why are we all suddenly afraid of Ebola, such that the World Health Organization has seen fit to declare that the epidemic is now an “international public health emergency”?

Ebola starts out as a disease that closely mimics the most common symptoms of flu—fever, chills, painful joints—and, if left untreated, triggers massive bleeding, with blood and other body fluids spurting out through vomiting and excretion, and through such body openings as the nose, ears and even eyes (although tears are not thought to be an infectious medium).

This recent Ebola outbreak has been traced to Guinea—with Liberia and Sierra Leone making up the deadly triangle of nations with huge outbreaks of the disease—more specifically, to a two-year-old child who died in December last year. The child then subsequently infected the caregivers, family members and even mourners who attended the wake.

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Authorities say there is no evidence that the Ebola virus (five types have been identified) is airborne or can be casually transmitted. Someone has to come in contact with an infected person, or more specifically with blood and body fluids (including saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and semen) that enter the body through open wounds, cuts and abrasions. Contact with contaminated objects, such as needles and syringes, may also be a mode of transmission.

This is why healthcare workers—who in the beginning of the current outbreak and in poor, underdeveloped settings of West Africa were inadequately protected and knew little of the disease’s mode of transmission—were among the first to fall ill and die.

But sexual partners of Ebola patients are also at risk. Some sources say the virus may be able to persist in the semen of survivors for up to seven weeks after recovery.

Otherwise there is a low rate of risk from recovered patients. Authorities say that usually when someone has symptoms (and therefore still infectious), “they are sufficiently unwell that they are unable to travel without assistance.”

Still, that didn’t stop one passenger from Liberia from boarding a plane to Texas where, some days after he reported for treatment in a hospital, he subsequently died. Missionaries who fell ill with Ebola were also repatriated to their home countries, infecting health caregivers there as well.

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And that is what makes Ebola so scary. It is not just the disease, but the speed and ease of cross-border travel these days that raises the risk of the disease blowing up into an international health threat.

Health authorities, including the WHO, reassure that in a country with “adequate” health infrastructure there is little to fear. If the systems in place at borders can keep track of infected arrivals; when healthcare workers have adequate protection; when experimental antidotes and treatments are available—there is little reason to fear an outbreak.

But that is precisely why so many eyebrows were raised when Philippine health authorities assured that there are enough protections raised against Ebola here to make sure that the disease does not settle here.

I would like to give the Department of Health and our health officials the benefit of the doubt. But is our health system really all that adequate? Arriving from China most recently, it turned out that I had failed to fill out the yellow arrival card given to every passenger, and was told I had to fill out a card before I could be allowed to proceed to the baggage area. I filled out the card, but no one bothered to take my temperature (was the camera able to determine my body temperature?) or ask me the right questions. Well, maybe because China is not (yet) an Ebola epicenter.

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Me, I would rather look on the bright side, and trust that our health officials, doctors and nurses are on their toes and ready to deal with the Ebola virus.

But it should give us pause as we approach Halloween that in this life, there are far more dangerous and real risks than running afoul of zombies, monsters, ghouls and ghosts. We have a lot to be scared of, including our own indifference and laziness, more than haunted houses and cemeteries after dark.

Worrying about Ebola should prod us to worry, as well, about how our tax money is being used to fight diseases (not just Ebola) in the here and now, and in places where the poorest and least cared-for among us can be found.