There were five invited plenary speakers: Michael Buchmeier (UCI) spoke about the virology of Ebola and the Filovriuses more generally. Hearing Mike’s insights on the not one, but two vaccines for Ebola that have been shelved for a decade due to lack of interest was particularly illuminating. George Rutherford (UCSF) talked about the epidemiology of the current EVD epidemic and placed control efforts within the broader context of Global Health Initiatives. This is a guy with a ton of experience in global health and on the ground in Africa and his cool demeanor was calming for the crowd. Victoria Fan (Hawai’i) discussed the economic implications of the epidemic. Spoiler alert: they’re not good. Shruti Gohil (UCI Medical Center) talked about infection control in a hospital setting. Finally, I talked about the disease ecology, broadly construed, of Ebola. Following our talks, we got together as a panel and took questions for the audience.
Given the crazy hysteria surrounding the EVD epidemic and the arrival of a handful of cases in the United States, it was reassuring to participate in a couple hours of such sober, scientifically-informed discussion. Shruti’s insights as chief of infection control at the UCI medical center particularly struck me. She noted that Texas Health Presbyterian Hospital in Dallas, where the first American EVD case (Thomas Duncan) was treated, was clearly completely unprepared to handle an acute EVD case. Despite this, Shruti estimated that the attack rate of health care workers who attended to Duncan was about 4%. Not that horrible for an unprepared hospital. She also noted that no health care workers have become infected in the special units specifically designed to handle infectious diseases like EVD at Emory, Nebraska, and Bethesda. Planning, strict adherence to protocols, and personal protective gear work!
So, let’s summarize a bit about EVD in the US (these are the numbers as best as I can remember them, with citations where I can find them):
Number of cases of evacuated aid workers infected in Africa: 4
Number of deaths of evacuated aid workers infected in Africa: 0
Number of travel-associated cases in US: 4
Number of deaths of travel-associated cases in US: 1
Number of cases of American health care workers: 2
Number of deaths of American health care workers: 0
Note that the one death (Thomas Duncan) might have been prevented if he hadn’t been sent home from the emergency room and gotten so much sicker.
Another interesting point that Shruti made is that none of Duncan’s close personal contacts have contracted EVD and the 21-day window has now passed. The clear implication of all these data is that Ebola is not that infectious. It is controllable if we are prepared and follow protocols.
This gives me hope that we can control the EVD epidemic in West Africa if we were to decide to get serious about its control. But the international community needs to fight this epidemic where it is currently raging. This is clearly in the national interest of the United States and the collective interest of the international community. If we want to remain secure from EVD, we need to stop it where the epidemic continues to grow. World Bank President, and medical anthropologist extraordinaire, Jim Kim pulled out a great analogy in an interview on NPR on 17 October:
It’s like you’re in your room and the house is on fire, and your approach is to put wet towels under the door. That might work for a while, but unless you put the fire out, you’re still in trouble.
Let’s get over our fear, stop politicizing this crisis, stop demonizing the heroes. Let’s roll up our sleeves, get out our checkbooks, and bring a speedy end to this crisis. Let’s put out the fire.