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First responders, health care workers must strictly adhere to protocols
YOUNGSTOWN
If the Ebola virus gets a foothold in the United States, quarantine signs — something not generally seen placarded on homes for more than half a century — likely will come back into use.
There is no vaccine for the Ebola hemorrhagic fever that has swept across Western African nations and has even touched the U.S.; and death-rate estimates range up to 80 percent of those infected.
While the National Institutes of Health announced Wednesday that human testing has begun on a second experimental Ebola vaccine, two local experts agree that for the time being, quarantine or social distancing are the best protections against spread of the disease.
And, absolute adherence to protocols recommended by the Centers for Disease Control and Prevention is the best protection for health-care workers and others caring for patients with potential or confirmed Ebola.
Dr. Daniel Ayana, Youngs-town State University history professor, and Dr. John Venglarcik III, Mahoning County Health Department medical director, also agree that the U.S., with its resources, is in a much better position than West Africa to prevent an epidemic in this country.
Health-care and ambulance personnel and other first- responders are the first line of defense, said Ayana, who this semester is teaching a class on plagues.
“The issue [in Dallas where nurses contracted Ebola] was overconfidence among hospital workers. They can’t ignore any protocol ... can’t leave anything to chance. Trying to learn as they go led to a very sad situation,” said Ayana.
The CDC says there was a communication breakdown. The nurses were saying parts of their bodies were exposed because the hospital thought the suit was adequate.
“To have the most success containing Ebola, centralized, standardized leadership is needed,” Ayana said.
‘a real effort’
If Ebola becomes widespread in the U.S., it will be through breaks in protocols by health-care personnel and others taking care of sick people, said Dr. Venglarcik, a pediatrician and infectious-disease expert.
Also, he said: “We have to ask where people travel. We have to make a real effort within the health-care system to identify people who travel outside the U.S. and understand they are a special-risk group.”
“We need to develop methods and protocols to meet traveler’s health needs as well as protect the people who don’t travel. We need to serve both groups,” Dr. Venglarcik said.
All of that being said, both men are optimistic that the U.S. will be able to prevent the wide spread of Ebola here.
A pandemic, a disease that crosses continents, comparable to Ebola is the cholera epidemic in the 19th century that started in India, went to Russia and Western Europe and then came to Canada and the U.S. — killing millions, Ayana said.
There are, however, also significant differences, he said.
“When cholera arrived, people didn’t know how it was transmitted or the source. They did not know the pathogen,” he said.
Pathogens are microorganisms, such as bacteria, fungi and viruses, that cause disease. They are commonly found in sewage, hospital waste, run-off water from farms, and in water used for swimming.
“In the case of Ebola, we know the source: Transmission from animals to people and people to people, which helps us contain it,” Ayana said.
For example, he said, the Ebola virus has been in Central African nations since 1976 and was isolated there until it recently spread to West Africa.
containment
Ebola was effectively contained for nearly 40 years in the face civil war, government corruption, an inadequate health-care system, and poverty, Ayana said.
The difference was that West Africa did not know about Ebola when it spread to there, and when it arrived, it was difficult to catch up.
“It overwhelmed the medical doctors, and while they were testing in labs trying to find out what it was, everybody died. That’s why we see doctors dying there. Protocols require resources,” Ayana said.
The point is, if Third World countries can successfully contain Ebola, the U.S. with all its resources should also be able to do so, he said.
“We don’t have a vaccine for Ebola; so for Ebola, quarantine is the equivalent of immunization for influenza,” Dr. Venglarcik said.
Ebola is a disease of poverty and social repression, he said.
Most who contract Ebola live in the bush where hospitals are in tin huts. They often don’t have sanitary water, and the social custom is for families to bury their dead, meaning when they clean up the body, they come in contact with blood and other bodily fluids, giving them a good chance of becoming infected. Also, their villages are closely linked, Dr. Venglarcik said.
Public health officials say, unlike influenza, the Ebola virus is not airborne and is much more difficult to contract.
Becoming infected with Ebola requires direct contact with an ill person’s bodily fluids, such as blood, semen, urine, saliva, sweat, feces, vomit, and breast milk.
limit damage
Despite the reality of Ebola in the U.S., Ayana and Dr. Venglarcik are optimistic the resources and circumstances necessary to limit its damage are available.
The way people die from smallpox and cholera are horrible; like Ebola, they cause the human body to degenerate, Ayana said.
However, the rapidity with which the diseases spread are different, he said.
For every patient infected with Ebola, the probability is they will infect two others; that compares with 10 for measles and a similarly high production for smallpox, Ayana said.
“The big point is that there should not be hysteria here, because if two Third World countries can contain Ebola, with our resources we should also be able to,” he said.
Ayana said, however, a centralized, standardized leadership is needed to have the most success.
The bigger picture is that humans live in very delicate balance with disease-causing organisms that continue to evolve, Ayana said.
“We can expect something like Ebola to happen again, but people should not panic. This is something that can definitely be contained,” he said.
The example is that smallpox, the disease that killed so many for so long, with a vaccine and good public health principles, was eliminated from the face of the earth, Dr. Venglarcik said.