Ebola garners global attention for being a merciless killer in sub-Saharan Africa. But its high fatality rate is due largely to bad health-care, say experts.
“The (Ebola) fatality rate should be close to 10 percent,” said Ophelia Dahl, Partners in Health president and executive director, at an event in Boston, held yesterday before the CDC’s announcement. “What Paul Farmer keeps saying is that Ebola has not met a modern medical system.”
Now, we will see just how powerful Ebola is when faced with a tough opponent in the form a robust medical system.
A man carrying the deadly virus from Liberia arrived in the United States on Sept. 20th, the Centers for Disease Control and Prevention reported on Tuesday. The unidentified person started to show symptoms on the 24th and was admitted and isolated in a Dallas hospital on Sunday.
Ebola continues to spread across West Africa. The latest estimates indicate that more than 3,000 people have died, roughly half of all cases. Earlier outbreaks in other African nations have reported fatality rates as high as 90 percent. But what’s often not mentioned is that these are also communities where people also have high fatality rates from otherwise easily treatable diseases like common bacterial infections, diarrhea or respiratory illnesses.
Ebola’s arrival in the United States will be dramatically different. With better health-care, Ebola doesn’t stand much of a chance.
“It’s a severe disease, which has a high case-fatality rate, even with the best of care, but there are core, tried-and-true public-health interventions that stop it,” said Dr. Thomas Frieden, director of the CDC, in a press conference on the Dallas case. “The bottom line here, is that I have no doubt that we will control this importation of this case of Ebola so that it does not spread widely in this country.”
The United States has managed to successfully treat two health workers who contracted Ebola. Dr. Kent Brantly and Nancy Writebol were evacuated to Emory University Hospital in Atlanta. Their recoveries are not by chance. While the current outbreak is killing roughly half of all people who get it, that is, in part, a reflection of the poor health-care systems in Liberia, Sierra Leone and Guinea.
If the three infected countries had the same quality of care available to most Americans, the fatality rate from Ebola would be about the same as for meningitis. In fact, improvements do not even need to reach the levels of high-income countries to see a difference. Both Nigeria and Senegal swiftly dealt with imported cases of Ebola. They immediately isolated any in contact with the infected patients, provided treatment and prevented Ebola from spreading. The CDC said yesterday that the outbreak in the two countries may be over.
With the case in Texas, Ebola now faces the U.S. health system. And there is good reason for the optimism shared by Dahl, Famer and Frieden. Texas Health Presbyterian Hospital of Dallas, where the new patient is being treated, held meetings about how to coordinate treatment for Ebola treatment as recently as last week, said the hospital’s spokesperson. The CDC has also been involved with the outbreak in West Africa for months.
“CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns,” said the organization in a release. “Knowing the possibility exists, medical and public-health professionals across the country have been preparing to respond.”
The Marburg virus is in the same family as Ebola, and is spread through the contact with bodily fluids. Its discovery came as the result of an outbreak in 1967 in Belgrade, Yugoslavia and the German cities Marburg and Frankfurt. Lab monkeys from Uganda were the culprits. Of those infected, roughly 25 percent died. That is compared against recent outbreaks in the Democratic Republic of the Congo, from 1998 to 2000, and Angola in 2005, where 80 percent of those infected died.
The vast difference in death rates is, in part, attributed to better health-care systems in the European countries. It is also why Australia announced that it will not send doctors to West Africa to respond to the outbreak. The government turned down calls to send a medical team due to concerns over the logistics of bringing potentially infected Australians home. The Australian Health and Defense departments are not confident they could safely bring home anyone infected.
“The Australian government is not about to risk the health of Australian workers in the absence of credible evacuation plans that could bring our people back to Australia,” said Foreign Minister Julie Bishop to the press.
While efforts are under way to provide better care for health workers in West Africa, the response by Australia illustrates its concern over the quality of care available to its citizens. Right now, the CDC is tracking down each person who came in contact with the infected individual when he or she was showing symptoms. People who were on the same flight as the individual into the United States aren’t at risk because no symptoms were present, the CDC said.
This procedure, called contact tracing, allows the government to isolate those who may have been exposed, prevent them from spreading it to other people and provide them with life-saving treatment. Ebola takes three weeks to incubate in the body, so the people who came in contact over the week the person was in the U.S. will have to remain in isolation for 21 days.
“Contact tracing is something we do day in and day out, and something we do well,” Frieden said at the press conference.
Those who contract Ebola will be treated. Those who are clear after the isolation period will be sent home. And that will be it for this case. U.S. hospitals have been preparing to potentially treat patients with Ebola. More cases may pop up over the coming weeks, but the full effort of the U.S. health-care system, from the federal government on down to primary care workers, is going to prevent a widespread outbreak.