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André Picard

André Picard

Ebola in Dallas is a soap opera – the real drama’s in Africa Add to ...

The soap opera unfolding in Dallas, where a patient has been diagnosed with Ebola, is an unwelcoming distraction.

Ebola is a problem – no, a crisis – in West Africa and that’s where attention and public health efforts need to be concentrated.

EBOLA: WHAT YOU SHOULD KNOW

Until the outbreak is contained at the source, it will continue to pop up in places like the United States, Europe and maybe even Canada. But the risk of contracting Ebola in Western countries is close to zero. The virus is not airborne; it is transmitted by exposure to bodily fluids, notably blood.

What we know about the Dallas patient is that he travelled from Monrovia, the capital of Liberia (the epicentre of the outbreak) on Sept. 19 and arrived in the U.S. a day later. He had no symptoms before or during the flight – patients on flights from Liberia undergo screening, such as being checked for fever, both before departure and upon arrival.

The patient was feeling ill and went to hospital in Dallas on Sept. 24 but staff did not suspect Ebola and he was sent home. (It is not clear if he was asked about his travel; patients with fever in ER are now routinely asked about their recent travel history, for precautionary reasons.) On Sept. 28, the man returned to hospital in critically ill condition, where he is now being treated.

On Tuesday night, officials from the U.S. Centers for Disease Control and Prevention held a press conference to discuss the case – some details of which had already been leaked to the media – and to reassure the public. The case was described as the “first case of Ebola diagnosed in the U.S.,” setting off a firestorm of interest and no small amount of hysteria. (Previous cases of U.S. health workers who contracted Ebola in West Africa and were transported back home for treatment garnered equally breathless coverage.)

The key point to remember is that the infections – including the new “U.S. case” – are all occurring in West Africa, more specifically in Liberia, Sierra Leone and, to a lesser extent, Guinea.

To date, more than 6,500 people have been infected and more than 3,000 have died, according to the official figures from the World Health Organization. It is universally recognized that these numbers are an underestimate. The fear and stigma is such that cases are not being reported, not to mention that health systems are so overwhelmed that people are unable to seek treatment, and public health officials are no longer able to keep track.

Ebola, like all infectious diseases, preys on poverty, chaos, and the unsanitary conditions and inadequate health systems that invariably exist as a result. It is not a coincidence that the West Africa countries where Ebola is spreading, in some cases at an exponential rate, are among the poorest in the world.

Ebola is not highly infectious. Its spread can be limited, even eliminated, with standard precautions such as wearing gloves and masks, hand-washing and disinfection of surfaces. But hospitals and clinics in countries like Liberia and Sierra Leone often lack these basic tools, meaning those at greatest risk are the nurses and doctors on the front-lines (including foreign volunteers), never mind people who are trying to care for gravely ill loved ones at home.

The situation is exacerbated by cultural traditions, whereby families clean and prepare bodies of the dead for burial, exposing them to blood and other infectious bodily fluids, and now by fear and paranoia.

Ebola is a disease that has been around for decades. The past outbreaks have been contained or burned themselves out relatively quickly, and without out too much carnage.

This time around, things are different. The response to the initial outbreak – which was identified last December in Guinea – was tepid. Where and when the initial cases occurred, and the failure to take them seriously, created a perfect storm for the unprecedented spread of Ebola. We are now paying the price for inaction.

There are dire predictions: Some mathematical models suggest there could be 1.4 million cases of Ebola by January, putting it in the same league as big killers like malaria and tuberculosis.

Ebola is a frightening disease because it kills quickly and gruesomely; there is no known effective treatment and no cure; but we can treat symptoms (and half of those infected survive, even in Africa) and, most importantly, we can prevent its spread easily.

To suggest Ebola is now “in the U.S.,” as we hear in many news reports, is misleading. It is a visitor, and an unwelcome one, but it can be easily handled by a modern health system. This anomalous case should not cause panic or distract us from providing help where it is needed. On the contrary, the best way to prevent travellers from carrying the virus around the world is to nip it in the bud.

The cost of treating one Ebola patient in the United States – or Canada, if and when it comes to that – could probably provide care to 1,000 in Liberia or Sierra Leone. That’s where our Texas-sized efforts need to go.

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Follow on Twitter: @picardonhealth

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The Globe in Africa: Geoffrey York on reporting from ground zero of the Ebola crisis (The Globe and Mail)

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