Forget about Ebola in the United States. Focus on Africa.

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I called it. I told you all that fear was spreading faster than Ebola, and now it has. A physician in New York City has come down with it after working with Ebola patients in Africa. With fear comes all sorts of stupidity. According to Reuters, this is what people are going through:

“When Zuru Pewu picked up her 4-year-old son, Micah, from kindergarten at a Staten Island, New York, public school recently, a woman pointed at her in front of about 30 parents and their children, and started shouting.

“She kept screaming, ‘These African bitches brought Ebola into our country and are making everybody sick!'” said Pewu, 29, who emigrated from Liberia in 2005. “Then she told her son, ‘You know the country that’s called Liberia that they show on the TV? That’s where these bitches are from.'””

Because all people from Liberia have Ebola, don’t you know?

I think you know. You’re a smart, thoughtful person. That’s why you read this blog. Unfortunately for all of us, way too many people are reacting stupidly to the Ebola situation, and way too many of them are in positions of power and authority.

Just last week, Senator John McCain called for an “Ebola Czar” while being completely oblivious (or just plain ignoring) the fact that we have been without a Surgeon General for a while now. Then there is Senator Rand Paul telling people that Ebola is so infectious that you can catch it at a cocktail party. And, not to be outdone, Representative Peter King tells us that the virus has mutated and that doctors are wrong.

And that’s just the politicians. Plenty of people on the street seem to be convinced that Ebola is more than we know it is. They read things online and believe them to be true. They read things like “Ebola has been manufactured” or “the CDC has a patent on Ebola” and think the worst. You just can’t preach rationality to those people. Worse yet, a lot of what they think about Ebola comes from a movie… A goddamned movie!

Sorry. I lost my cool.

No. You know what? I have a right to lose my cool. We all should lose our cool with idiots who promote ridiculous things about Ebola — and other diseases — like the religious zealots in Liberia who are blaming Ebola on homosexuality and getting people hurt. We should not stand for all this bullshit and fight it with facts, with reason, with science, evidence and all those things.

When some jerk like Donald Trump loses his mind and blames the President of the United States, we need to fire back and remind him of a simple fact:

Hat-tip to Tara C. Smith.

Hat-tip to Tara C. Smith.

When Governor Rick Perry of Texas shouts that we need to shut flights from West Africa — which would essentially kill their economy and infrastructure — we need to remind him that more people have died from West Nile Virus in Texas than from Ebola in Texas. So what is he going to do about West Nile Virus? Surely not panic.

Look, there are a ton of different things more likely to kill you in the United States than Ebola. We are blessed/lucky/fortunate to have a robust healthcare system. If you get sick in just about any county in the country, you can call on an ambulance to take you to a hospital. By law, that hospital must treat you until you’re stable. If you happen to get Ebola, you are much more likely to survive here than you would in West Africa.

Which leads me to my next point. You would think that the outbreak in West Africa is over from the news coverage that it has not been getting and by the slowness in reacting from all the governments and people in the world. Why is it that humanitarian organizations have to go begging for donations to fight Ebola in Africa while anti-vaccine organizations waste money buying themselves congressmen? And how the heck is Cuba — with all the things we’re told about it — doing a better job responding than America?

When people ask me about their risk of this disease or that, I take into consideration the population-level things that determine that risk. People like my wife who are healthcare providers need to determine both population-level factors as well as individual factors in telling someone their risk. When it comes to Ebola, the whole of the population is at lesser risk of contracting it than getting hit by lightning or dying in a crashing plane. The risk is only slightly higher for healthcare workers taking care of a person with Ebola here in the US, or for a person living with an Ebola patient.

All this paranoia and idiocy in reacting to Ebola is not going to help the people who really need to be helped: the people in West Africa. They don’t have the luxury of calling for an ambulance or going to a good hospital. Heck, they barely have doctors. No, not “enough doctors.” They barely have doctors, period. They don’t get to go to an urgent care center or an emergency department and whine over not getting their percocet or other painkillers.

So let’s fight for those people and stop the spread of misinformation. Spread the right information. Listen to the science.

For God’s sakes, get a grip!

  1. Will von Kaenel October 24, 2014 at 22:41

    Are you interested in discussing any ascpects or assertions in your rant, or is this a one way thing, as might be expected with a rant?

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    1. Sure. I’m in the mood for a discussion. What’s up?

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  2. The problem is twofold. On one hand, politicians desire “to be seen doing something”. On the other hand, fear sells and ignorance seems to be welcomed in one particular party.

    Oh, you missed the other wingnut one, where ISIL “is plotting with Mexican drug cartels to bring Ebola infected people into the United States to attack Arkansas”.
    Because, Muslim fundamentalists of a weird innovation of faith would team up with suppliers of the Haram.

    Geeze, I remember when the GOP was trumpeting having the most scientists and engineers in the world, back when Saint Reagan was POTUS. Now, they disparage the “intellectual elite” (and other disparagement of having anything greater than a sixth grade education).
    It all makes me consider something I said long ago, in a foreign nation where schools were being blown up.
    A well educated populace is impossible to control, a poorly educated populace is trivial to control.

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    1. Oh, the whole “Mexicans will do (insert favorite paranoia here)” thing has been done since I can remember. In fact, I remember when they gave amnesty to all those undocumented workers back in 1986. I was seven years old, and I remember hearing all the things “those Mexicans” were going to do to the United States. And it never happened.
      The same was said of Italians, Jews, you name it.
      That’s what makes Ebola so scary in terms of the xenophobia it’s unleashing. Remember the Hatians in Guantanamo because of AIDS? We are making it worse now. Yet another thing the next generation or two will have to apologize for.

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      1. I’m also reminded of the Japanese internment camps, which were officially called concentration camps until the Nazi versions were discovered.
        There were also suggestions to intern Germans and Italians, but the mafia was too useful in ensuring dock security (trust me on that one, I read the classified version of the story).

        Whenever the “immigration fever” strikes the village idiots, I rather firmly reply that my paternal grandparents names are on the plaque on Ellis Island, my maternal line is Sons and Daughters of the American Revolution. That qualifies me as a distilled SOB.
        Then, I proceed to expose the disgraceful past of the United Fascist States of America, with each immigrant group blamed for all manner of nonsense, to include “stealing jobs” that nobody else wanted in the first place.
        And well, the Mexican immigrants did what they did, largely sharecrop. Where I work, there are a fair number of farms nearby. Interestingly enough, there are a lot of taco stands and real Mexican restaurants. And as usual, the local Mexican-American populace are moving up the economic ladder quite smartly.

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  3. I rather enjoy your blog posts, especially when you use strong words to back up your comments.

    It’s a shame that people’s behaviors toward Africans and toward LGBT individuals is harsh and based on misinformation about the the nature of Ebola virus infections. I’m reminded of the early days of the AIDS crises, when the mere mention of the disease evoked violent responses toward those who were infected.

    Thanks for all you do to educate us and for another great post.

    Liked by 1 person

    1. And thank you for reading.

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  4. Will von Kaenel October 25, 2014 at 02:12

    Epi Ren–

    Okay, here’s some discussion. You state:

    “The risk is only slightly higher for healthcare workers taking care of a person with Ebola here in the US, or for a person living with an Ebola patient”

    If the risk is ‘slightly higher’ to HCW, what is your quantitative estimate for that risk? I only see vague qualitative assessments. and when I’ve asked experts to be more definitive objections are raised to the question (or the questioner), rather than address the issue forthrightly.

    The Bureau of Labor Statistics publishes the census of fatal occupational injuries.

    http://www.bls.gov/iif/oshwc/cfoi/cfoi_rates_2013hb.pdf

    For 2013 in US hospitals there were 24 fatal injuries, and a fatal injury rate of 0.5/100k/yr.

    By way of comparison, logging was the most dangerous occupation, with a fatal injury rate of 86.5/100k/yr.

    Based on the experience of organizations in W. Africa such as MSF, and that in Spain and the US, what do you estimate would be the annualized infection rate in HCW? What would be the HCW Ebola mortality rate? From this, what would be the US Ebola HCW fatal injury rate in fatalities/100k/yr? Obviously this is not an easy question, but there is at least some experience and data upon which to base an estimate, as evidenced by your description of this risk as ‘slight’.

    http://www.doctorswithoutborders.org/article/ebola-msf-staff-member-us-hospital

    Is there a level of US Ebola HCW fatal injury that you would deem unacceptable? For example, would it be acceptable if the rate was >87/100k/yr, and that Ebola HCW was the deadliest occupation in the US?

    It seems to me that this question of US HCW safety is of great pith and moment. If I understand correctly, the CDC strategy for US containment of Ebola is to admit symptomatic Ebola patients into hospital isolation, so that the later much more infectious phase will be there contained. If this strategy turns out to entail unacceptable levels of HCW fatal risk, I am unaware of any Plan B.

    I look forward to your (or anybody else’s) thoughts on this subject.

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    1. The issue cannot be raised outrightly because there is a lot wr don’t yet know about Ebola and how it behaves here in the States, or in West Africa really. My statement was an opinion based on over seven years of infectious disease epidemiology and twenty of laboratory technology. And I wrote that it is slightly higher because the risk isn’t all that high to begin at a population level. That’s my level of experise when it comes to risk assessment. Furthermore, I’d wager that anyone giving you an actual quantitative risk assessment is doing calculations on the back of a napkin or in their head.
      We know that there isn’t a horde of infected people in the US. We also know that you need to be very viremic — and thus very sick — to infect others. By that time, you’re either laid out in bed or at a hospital, and so you’re not in the general public. Thus my assessment of risk to the general population.
      As to plan B, I think you’re right. There is no national, coordinated plan B. That is what happens in a federal democracy with over 300 million people. I’ve heard from colleagues in China and Russia on their plans B, C, and D. No one in the US would tolerate plan D. We value our freedom above the survival of the human race, I guess.
      Sorry I don’t have the quantitative answers you’re looking for. Those will come with time, hopefully before next time.

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  5. Will von Kaenel October 26, 2014 at 00:04

    In your piece you state:

    “By law, that hospital must treat you until you’re stable”

    The ‘hospital’ is an entity, an organization. it cannot treat anyone. it is the health care workers that treat.

    Are health care workers to be arrested if, unsatisfied with the vague assurances of those that bear no risk, they refuse to treat Ebola patients? Or if they call in sick, as is reportedly happening at Bellvue?

    Since you are an infectious disease epidemiologist, and the occupational risk to health care workers is infectious epidemiology, it does not seem to be out of your wheelhouse to take the Ebola HCW record so far in Africa, Spain and the US to make at least a back of the envelope calculation. Your piece doesn’t seem to shy away from stating some definitive opinions, and calling into question the judgement of others, after all. If you state that the risk to HCW is ‘slight’, I’d think that you’d be keen to back up your statement using your epidemiological expertise.

    No envelope is needed to render your opinion as to the acceptable level of fatal risk to HCW. I’ve provided a handy link to BLS data for you to peruse. You assure HCW that the risk is ‘slight’, which describes the 0.5/100k/yr risk to HCW now extant. Is 5/100k/yr acceptable? 50/100k/yr? 100/100k/yr?

    You agree that there is no Plan B if actual HCW risks > acceptable HCW risks. Maybe the ‘hysteria’ against which you inveigh might have something to do with the public’s surmise that even experts with a penchant for scolding rants don’t really have this all thought through.

    To summarize:

    -You don’t have any idea what are the fatal risks to health care workers.
    -You can’t/won’t state what is the acceptable level of risk.
    -There is no solution at hand if actual risks>acceptable risks, and the government’s only containment technique proves unworkable.

    As I stated, I cannot get any other Ebola experts to address these issues. So, if you don’t either, you’re not alone.

    .

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  6. And you’re done, Mr. von Kaenel. Thank you for commenting, but this is the last comment of yours on this blog that I will respond to. You may not accuse me of any of the things you mention. I won’t allow it. Not on my blog. Go start your own blog and bully people into telling you unmeasurable things from there. You’re likely on some sort of a “trip” if you think that a handful of cases in the US and one in Spain will allow me, or anyone, to explain to you an exact risk of catching Ebola. It is beyond a delusion to demand so.

    I told you the reasoning behind my assertions. Period.

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    1. Well, a quick educated guess of the number of personnel directly involved in an Ebola patient’s care, testing bodily fluids, etc can be made.
      A minimum of 3, typically 4 nurses are required for care, as a 12 hour shift is common, but most nurses get two days off per week. A like number of technicians, such as phlebotomists, as many or more physicians as well. Add in a half dozen lab workers. Add in housekeeping disposing of the contaminated waste.
      So, for one patient, there are at least 22 involved in caring for one patient. Let’s round it up to 25 for a more reasonable number.
      Per patient.
      Number of Ebola patients is what now, six total, counting ill medical workers evacuated home for treatment?
      Only two cases were in the same facility and professionals can move from one patient to the next as needed.
      So, we have 125 workers at a minimum and two became ill.
      And with any new type of infection, there is a learning curve. Compare HIV cases contracted by accidental needle sticks over the course of the AIDS pandemic and you’ll see a lot early on and few today.

      One cannot count West Africa infected, due to confounding factors, such as supply issues and equipment re-use.

      Now, I’ll circle back to that inexperience part for a bit.
      My experience is from military medicine. I was, along with a host of other duties, assigned to nuclear, chemical and biological warfare treatment. That means that I had to learn to be very proficient in donning and removing several types of protective equipment sets, ranging from the field kit used by all US service members to hazmat style suits to regular hospital issue gown, mask and face shield.
      It’s trivially easy to breach protocol and not notice the breach, contaminating oneself with something highly lethal.
      When I trained others, as a final exam, which frequently ended up being repeated, I took to spreading methylene blue on various high risk areas of the protective garment. Any blue skin is a dead man and the test will be repeated at a later date.
      It was quite effective. A few never managed to acquire the necessary skills and those people were reassigned.
      Because, the last thing I needed was someone needing treatment from a nerve agent, a blister agent, a blood agent, a biological agent or spreading nuclear contamination all over a treatment facility!

      Now, in this case, there are many confounders. As I said, experience drives lower risks of exposure.
      For business cases and hospitals are a business and have to balance costs vs effectiveness.
      Single loss expectancy x Asset value = Exposure factor
      Now one has to estimate the annual rate of occurrence (ARO).
      Now you have to determine the annual loss expectancy (ALE). ALE is calculated as follows:
      Annualized loss expectancy (ALE) x Single loss expectancy (SLE) = Annualized rate of occurrence (ARO).

      In performing these calculations, one has to account for lost productivity, cost of treating an infected employee, the value of that employee (counting training a replacement, recruitment costs, etc), cost of disability of an employee.
      Now, where do we acquire the numbers to compute the ALE?
      Observing trends, analyzing data and the one who does that is an epidemiologist. Once there is data available to analyze.

      Oh, I know those equations for a reason. I’m now in information assurance and have to calculate the cost/benefit ratio to determine if particular mitigation efforts are worth the effort.
      You don’t spend a thousand dollars to protect that which is worth one hundred dollars.
      One does not wear biosafety level 4 equipment to treat an Ebola patient.

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    2. Wow. What do the yearly fatality numbers for loggers and other non-health-care workers, have to do with the risk for HCWs who provide care for Ebola virus patients?

      Are loggers now qualified as HCWs and are they now caring for these patients?

      I have three colleagues who are public health nurses and are Board Certified Infection Control Practitioners, who are training HCWs in hospitals in New York City:

      http://www.cbic.org/certification

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      1. Well, loggers and nurses are quite alike.
        As alike as apples and oranges.

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  7. […] Forget about Ebola in the United States. Focus on Africa. 2014-10-24 […]

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  8. […] Forget about Ebola in the United States. Focus on Africa. 2014-10-24 […]

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