Fears that Ebola is just one plane ride away from the U.S. and other countries have come true. Thomas Eric Duncan traveled from Liberia through three airports, was sent home from the Texas Health Presbyterian Hospital with antibiotics, then returned two days later and was diagnosed with Ebola. Thousands of people encountered or crossed paths with Duncan. It sounds like the plot of a movie (oh right, it has been in several, such as Contagion). But, can fears that Ebola will spread rapidly here like in Africa come true? What can be learned from the Duncan experience?
First, the odds of Duncan having spread Ebola to people he encountered on the trip are slim to none. He left Liberia on Sept. 19, traveled through Brussels, Belgium, and the Washington, D.C., area, before arriving in Dallas, Texas, on Sept. 20. He did not feel sick until Sept. 24. Duncan was clearly exposed before leaving and incubating the disease while traveling.
However, Ebola is not contagious until the symptoms begin. Those symptoms resemble a bad influenza case (high fever, headache, muscle aches and upset stomach) up until the point the unexplained bleeding begins.
Ebola is transmitted through direct contact with bodily fluids or objects contaminated with the virus, like syringes. Being around someone carrying Ebola does not present a problem if no symptoms or contaminants are present. In Africa, the virus spread out of control because the custom there is washing the body of a loved one who has died and people caring for contagious people without protective gear. In both situations, there is exposure to bodily fluids.
The problem and reason for any concern in Texas is that Duncan first felt ill on Sept. 24, first went to the hospital Sept. 26, but was not admitted or tested until he was critically ill on Sept. 28. People he encountered during that period, which was mostly family but included the people who examined him at the Texas Health Presbyterian Hospital on both visits, have been exposed. As a result, public health officials in Dallas have identified people who may have been exposed to monitor for symptoms in the next couple of weeks.
Protective Measures Needed
The U.S. Centers for Disease Control and Prevention (CDC) has not recommended monitoring people who were on Duncan’s flights or any other flights from the afflicted areas. They do not see the need to make any changes in airport procedures.
This is different than the way Severe Acute Respiratory Syndrome (SARS) was handled in 2002. During that deadly outbreak in several countries, travelers to and from affected areas were given handouts, asked to fill out questionnaires about possible exposure to SARS, and more. The difference then was that SARS was more easily spread. A respiratory illness, SARS could be spread through coughs and sneezes, besides bodily fluids. People actually wore masks on flights to not breathe in germs from others.
However, it would be a good idea while Ebola, MERS, SARS and other deadly viruses are spreading in regions for officials to note where a person is coming from and ask them questions about possible exposure like those in 2002.
Additionally, people who present in Urgent Care or Emergency Rooms with severe stomach cramps or diarrhea are sometimes asked if they have eaten anything strange or traveled recently. Duncan was not asked on his first hospital visit if he might have been exposed to anything or traveled from West Africa. Maybe travel questions should be routinely asked, at least when a deadly virus is spreading in a part of the world the person may have been in.
The CDC has acknowledged that a single case of Ebola diagnosed in the U.S. has raised fears that an epidemic can come true here. They emphasize that public health officials are taking precautions to isolate and control infection. Hopefully, they will tighten them, given the lack of concern displayed in Duncan’s case until Ebola was suspected.
By Dyanne Weiss