Ebola Comes To America: First U.S. Ebola Case Just Diagnosed In Texas

Standard
Ebola has arrived in America: A patient in Texas has been diagnosed with the deadly disease, the CDC confirmed on Tuesday.

It is the first case of Ebola diagnosed in the United States. That’s
an important distinction because — unlike the medical workers who contracted Ebola in Africa
and were flown back to the United States for treatment — the new Ebola
patient could’ve been circulating in the general U.S. population,
potentially spreading the disease.

From Last Week: Is Ebola Coming To America? Experts Ponder As Ebola Epidemic Rages In Africa

However, experts have stressed that Ebola does not transmit easily,
but instead requires “intimate” contact with someone who’s infected.
“Ebola poses no substantial risk to the U.S. general population,” CDC
said earlier this month.
The U.S. patient diagnosed with Ebola is a man who was traveling in
Liberia, and he started showing Ebola symptoms four days after
returning. The man has been placed in “strict isolation,” according to a
statement from Texas Health Presbyterian Hospital of Dallas.
In a briefing on Tuesday, CDC officials stressed that because the man
was not symptomatic with Ebola while flying, there was “zero risk” of
transmission for other passengers on the plane. They also vowed that
public health officials “would stop [Ebola] in its tracks in the U.S.”

Outbreak Currently Raging In Africa

As I wrote about for Forbes last week, the current Ebola outbreak in West Africa is already the worst on record. And it’s only gotten worse.
More than 3,000 people have died, and CDC estimated that as many as
1.4 million people in Liberia and Sierra Leone could contract Ebola by
January 20. That’s about one in seven members of the population.
(For a sense of perspective on CDC’s worst-case scenario for West
Africa: If a similarly sized outbreak happened in the United States,
more than 45 million Americans would contract Ebola.)
Ebola has hit doctors and nurses especially hard: More than 200 health care workers have already died from the current Ebola outbreak in Africa.
And that’s a reminder that the Americans who initially treated the
Texas patient diagnosed with Ebola might be at elevated risk. “What
wasn’t said in the CDC Ebola briefing,” reporter Helen Branswell pointed out on Twitter. “Where did the patient seek care on Sept. 26? Did his visit lead to [health care worker] exposures?”
The longer the Ebola outbreak goes on, the greater the chance that
the disease could mutate, too. Scott Gottlieb, who served as a top FDA
official under President George W. Bush, has warned that there’s even a chance that Ebola could go airborne, although other experts are pessimistic.
The World Health Organization also warned that given the scale of the
outbreak, there’s a possibility that Ebola will go from epidemic to
“endemic” in West Africa — essentially, the disease won’t go away, but
continue to afflict the local population. That’s “a prospect that has
never previously been contemplated,” WHO researchers wrote in the New England Journal of Medicine.
Writing in the Washington Post on Monday, epidemiologist Gerardo Chowell-Puente noted
that each case of Ebola in the current outbreak is producing about 1.3
to 1.8 secondary cases, on average. And that pace of transmission is
especially troubling given Africa’s weak public health response,
Chowell-Puente writes:

To break the chain of the current Ebola epidemic, our numbers show
that health-care workers need to stop about 50 percent of infectious
contacts by effectively isolating people who are infectious…

The trouble is that the countries suffering from outbreaks have weak
health-care systems – perhaps too weak to halve the number of
infectious contacts.

These countries lack gloves, gowns, face masks and other essential
supplies to protect nurses and doctors from infection, and they don’t
have an adequate surveillance system to catch and identify Ebola cases
in a timely way. The number of doctors and health centers is small as
well.

There are signs for hope, however. In Africa, Nigerian public officials have successfully “broken
the chain” of Ebola transmission. And the U.S. public health response
is considerably more organized and stronger than the public health
framework in Africa.
Emory Healthcare in Atlanta has already treated three victims of the
current Ebola outbreak. Two of those patients — Kent Brantly and Nancy
Writebol, who were doing missionary work in Africa — have since been
discharged.
Why did Emory take on those patients? How did staff respond?
I spoke with John Fox, CEO of Emory Healthcare, in an interview
for the Advisory Board Daily Briefing — and he stressed that he would
do it again. “This is our mission. This is the reason we exist,” Fox
said.
Every Emory patient who treated the Ebola patients volunteered to do so.
Emory staff care for an American missionary who contracted Ebola in Africa. (Graphic via Los Angeles Times.)

Emory staff care for an American missionary who contracted Ebola in Africa. (Graphic via Los Angeles Times.)

How Ebola Kills You

Ebola’s initial symptoms include fever, headache, diarrhea, and
vomiting — all of which sound misleadingly common and relatively
treatable. But the disease can quickly progress, with mortality rates of
upward of 70%.

“At the end stage of the disease, you have small leaks in blood
vessels,” Thomas Geisbert, an immunologist at the University of Texas
Medical Branch at Galveston, told NPR in August. “You end up with essentially no blood pressure. Your body temperature drops and you go into shock.”

That’s largely because Ebola can provoke a “cytokine storm” in the
body, as the immune system launches an all-out response to fight off the
disease — which simultaneously ravages a human body, damages blood
vessels, and further lowers blood pressure to dangerous levels.

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