A smart virus is a worthy adversary to the brightest of scientists. A virus that presents itself in classic fashion; with high fever, headache, sore throat and abdominal pain. This is how adenovirus, ebstein-barr virus, enterovirus, and the coxsackie virus can also present, as well as countless unnamed other infectious agents. They all look the same at first glance. It is only with time and progression of symptoms that the diagnosis becomes clear— a rash develops on hands and feet and hand-foot-mouth is diagnosed, blood is drawn from the ailing patient and mono is detected; vomiting, diarrhea and hemorrhaging develop and now, today, Ebola must be considered. Sometimes we never categorize an illness beyond viral, but luckily our patients almost always improve through simple supportive measures. That is really the distinguishing factor here, the mortality rate of something as debilitating and pervasive as the seasonal flu is only about 2-4%, compared to the horrendous survival rate of Ebola in its current form. In almost all cases of viral infection, our collective immune systems prevail; we as a species have proven the victors time and time again.

In medical school, I learned a great deal about the novel Spanish Flu of 1918 that used our most powerful weapons against us. This flu spread its viral wings and soared across humanity eventually killing 3-5% of the world’s population, or 50-100 million people. What was devastating about this particular H1N1 flu strain was that it incited the immune system to work against itself, so rather than preying on the facets of the population with weaker defense systems – the elderly and the very young, it attacked and killed with ferocity young healthy adults. It created an internal storm in its host, fueled by our complex internal protective measures. The Spanish Flu was a very smart virus.

Ebola, of course, is a smart virus as well, a virus that enters its host through serum proteins and generates numerous copies of itself by utilizing ever-present host enzymes. Once within the serum of its host, it replicates rapidly, causing suppression of the immune system, dysregulation of organ function and resultant clotting failure and organ demise. The survival rate with supportive measures alone is only approximately 50%. Current treatment options are being explored and two vaccines are under study, but we should expect very little from these interventions at this time. So, how is this virus spread? Through direct contact with the bodily fluids of an infected and symptomatic individual, primarily through the mucous membranes of the nose, mouth and the conjunctiva of the eye. Think about how “pink-eye” is spread, not through suspended infected droplets in the air, but through direct contact with infected secretions. Ironically, it is both easy and difficult to catch pink-eye.

As you know, a nurse at Presbyterian Dallas has been diagnosed with Ebola after directly caring for Mr. Duncan. She was noted to be following contact precautions including gloving, gowning and donning a mask while caring for Duncan. The “breech” in protocol likely occurred with removal of contaminated gear and the presence of a microscopic virus-laden droplet of fluid left on her hand that then came into contact with her mouth, nose or eyes. I really don’t think it makes sense to blame her, or Texas Presbyterian protocol. I remember being a resident doctor at Children’s Medical Center and caring for patients with highly contagious diseases, such as Tuberculosis. I would gown, glove and mask before entering the room, but there were times when my mask would slide a bit and my gloved hand would instinctively/habitually reach up to my mask to readjust. Healthcare workers are clearly at greater risk of infection, and many people caring for Ebola patients worldwide have been infected and died. As said by Dr. Thomas Frieden, director of the CDC, “Unfortunately, I would not be surprised if we did see additional cases among the health care workers who treated the index patient.”

I really don’t think it’s time to panic, but I do think we are in a highly precarious situation.

How do we move forward?

  1. Keep your ill children home from school- if they have a fever, they are contagious. Keeping them home will protect their classmates from illness, minimize panic among school personnel and parents, and even confer support to your child’s own defense system as it generates antibodies and acquires strength in fighting illness.
  2. Remember that although it is possible to contract Ebola through exposure to an infected, symptomatic person’s bodily fluids, it is not possible to contract Ebola by passing an infected person on the street. Live your life, be kind, but be smart. Wash your hands regularly, carry sanitizer that is at least 60% alcohol, avoid overly crowded environments and people that appear visibly ill.
  3. Remember to use the CDC website for your official source of internet information on the subject. There is always speculation and creative fictional diatribes, but the CDC will provide up-to-date, clear factual information.

 

Hopefully, Nina Pham, the nurse at Presby that has been confirmed infected with Ebola will recover completely and no new cases will be diagnosed in our home region. Hopefully, we will have time to develop effective treatment protocols and vaccines. Hopefully, we will have time to ensure adequate numbers of medical staff to safely recognize, diagnose and manage future cases, because surely this will not be the last we see of Ebola. A virus as smart and destructive as this one will demand our full attention.