Wednesday, October 1, 2014

Why the Ebola Crisis COULD Be Worse Than What is Being Stated

Before I begin this article, let me be very clear that I am not a doctor. But I am capable of research, and want to note that the source material I used for this article was from one that should be considered reliable. All data, unless otherwise noted, is taken from the following  website:

The CDC and the federal government are advising us not to worry in the wake of revelations that Ebola has now been confirmed in a patient in Dallas. And that is their job, to prevent the public from going into a state of panic. And even with widespread concerns, it's still sound advice to not panic. But it is also sound advice to look at the very real possibilities that this could become more of a concern than they are saying.

Of utmost concern is what we now about the first patient diagnosed with Ebola in the US. He first showed symptoms of the disease on September 24. He sought treatment on the 26th, but was sent home because the hospital personnel did not believe it to be a serious disease, despite his advising them that he was from Liberia. He then returned on the 28th, and was quarantined (source:

So there were four days between the onset of symptoms and quarantine. Four days in a large city where the virus could possibly have been transmitted. Note: I am not saying it WAS transmitted, I am just saying that IF it was, it could be a very serious problem. Here is why:

In the United States, many low paid workers do not take off work when symptoms of illness appear. Many do not have sick days, and fewer still have the money to afford a doctor's visit, even with insurance coverage under the ACA. So the first few days of symptoms, they are likely to be at work, and exposed to the general public. Unless the CDC can properly identify everyone who had contact with this individual, the chances of this happening are actually better than we realize.

Here's where it gets interesting: the CDC reports that there is no possibility of ebola being transmitted though airborne contact. Two potential problems with that are possible contradictory evidence (, and the nasty tendency that viruses can have to mutate, the limits of which are still not fully understood. Still, for the sake of this analysis, I will accept the CDC's conclusion on this matter to be absolute (although I would encourage you not to assume it).

So the means of transmission are through blood or bodily fluids, right? Assuming these are the sole means of transmission, there are still plenty of innocent ways that the virus could be transmitted.

First, the fast food culture: The source information from the Public Health Agency of Canada (linked at the beginning of the article) notes that the virus can survive under certain conditions for up to 50 days outside the host. It is particularly viable at low temperatures, so the likelihood of it being transmitted by a grill cook or someone else behind the lines is fairly minimal.

But hot foods are not the only thing served by the fast food industry. The 50 day survival rate was at 4 degrees celsius, or 39.2 degrees Fahrenheit...almost exactly the temperature of the average refrigerator. This means that refrigerated products bear a high likelihood of being host to the virus for almost two months if the body fluids of an exposed individual make contact.

With the holiday shopping season around the corner, I would consider that especially worrisome.

Then, going further, the tables. If infected patients sit at the tables and wipe their noses and touch the tables, there is a potentially infected source. The good news is that ebola can pretty much be wiped out by many commercial disinfectants; the bad news is the tables would need to be wiped with disinfectant between each patron, something I have never seen at any fast food restaurant I have patronized. In fact, it's more likely to be wiped with a wet cloth that has simply been run under the faucet, a condition which could actually further the transmission.

In case someone is reading this wondering how to minimize the risk of infection, I am including the paragraph from the PHAC site below. I would encourage you to follow the first link for additional information:

SUSCEPTIBILITY TO DISINFECTANTS: Ebolavirus is susceptible to 3% acetic acid, 1% glutaraldehyde, alcohol-based products, and dilutions (1:10-1:100 for ≥10 minutes) of 5.25% household bleach (sodium hypochlorite), and calcium hypochlorite (bleach powder) Footnote 48 Footnote 49 Footnote 50 Footnote 62 Footnote 63. The WHO recommendations for cleaning up spills of blood or body fluids suggest flooding the area with a 1:10 dilutions of 5.25% household bleach for 10 minutes for surfaces that can tolerate stronger bleach solutions (e.g., cement, metal) Footnote 62. For surfaces that may corrode or discolour, they recommend careful cleaning to remove visible stains followed by contact with a 1:100 dilution of 5.25% household bleach for more than 10 minutes.

The second area of concern is day care centers and church nurseries. Sick children aren't supposed to go to daycare, and many day care centers are very firm in their policies of not accepting sick children. Assuming the CDC information to be accurate, those centers should really have little to worry about. But again, we live in a world of reality, and there are not enough of those centers to serve all of our children. And children are notorious sharers of bodily fluids, whether it be from chewing on a plastic doll and handing it off to a colleague, wiping snot on the craft table, or the frequent bloody noses from the toddler X Games that frequently go on.

The risk of infection could drop to virtually nil if thoroughly disinfecting contact surfaces with the above noted information in mind were followed, but with the CDC information limited to "don't panic", the information may not get where it needs to go. All of the information, of course, is good general infection control information, but since we are dealing with a disease that carries a high mortality rate, it wouldn't be a bad idea to revisit this.

The third area of concern is public transit. For brevity's sake, I am going to couple this with the scenario of a driver stopping to render aid in an accident. Our daily public contact puts us in places where we may be susceptible, particularly in crowded cities.

The fourth area, though, is probably the area of greatest concern if the disease reaches the wrong population. It can be transmitted through shared needles, as can HIV, but the virus remains viable in a patient from 61 to 82 days after the onset of illness, and transmission through semen has occurred 7 weeks after full recovery. This means that if the "don't panic" protocol is the only one observed in the US, there are entire segments of the population very much at risk without this information.

Let me again restate that I am not a doctor, and am only operating with published information. I researched this in order to alleviate my own concerns, and found additional concerns in the process. It is not as innocent or casually containable as the CDC suggests, though, although you probably will be safe in suburbia. But a large percentage of the population lives outside of suburbia, and they deserve accurate information, not casual dismissal of their fears.

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