Maryn McKenna

Journalist and Author

Ebolanoia: The Only Thing We Have to Fear is Ebola Fear Itself

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Star5112 / Flickr

It is almost a month now since Thomas Eric Duncan appeared at the emergency room of Texas Health Presbyterian Hospital, was sent home after evaluation, and returned two days later with symptoms of Ebola. On Monday, his family and the health workers who treated him at the hospital were released from quarantine, with none having fallen ill.

But if you’ve been paying any attention to the Ebola news, you’ll know that the story is far from over, with one nurse who took care of him in Dallas now hospitalized at NIH (and upgraded to good condition Tuesday) and the other at Emory University, where the aid workers who fell ill in Africa also received treatment and recovered. Duncan remains the only person who came to the US with Ebola but not already identified and under medical care.

Given our nationwide reaction, though, you might think we have had as many cases as West Africa.

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What Would Keep Ebola from Spreading in the US? Investing in Simple Research Years Ago.

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

There’s a thing you learn, when you’ve been writing about infectious diseases for a while: People love drama. They’re not so much with detail.

Drama is H5N1 avian flu killing half the people who contract it, and the enormous surge in whooping cough, and the sinister movement of almost-untreatable NDM-1 resistance from South Asia to the West.

Detail is the question of whether health care workers treating pandemic-flu patients should expect viral spread for 3 feet or 6 feet; and why immunity conferred by the current pertussis vaccine fades a few years earlier than expected; and how hospitals can encourage their janitors to clean rooms more thoroughly, when they’ve always treated them as a disposable part of the staff.

All of those details are crucial to controlling those diseases. All of them are also research questions. None of them, guaranteed, have gotten the attention or funding that would answer the questions in a way that equips us to counter the dramatic problems.
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US Will Screen Air Passengers for Signs of Ebola. Will It Work?

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Masked customs officers look on in a screening area for international passengers from United flight 998 from Brussels at Newark airport in Newark, N.J., Saturday, Oct. 4, 2014. New Jersey health officials say Ebola has been ruled out as the cause of illness for a man who became sick on a flight from Brussels to the United States.

Masked customs officers look on in a screening area for international passengers from United flight 998 from Brussels at Newark airport in Newark, N.J., Saturday, Oct. 4, 2014. New Jersey health officials say Ebola has been ruled out as the cause of illness for a man who became sick on a flight from Brussels to the United States. Viorel Florescu / AP Photo / Northjersey.com

If you’ve been following the Ebola story, you may have noticed that the Centers for Disease Control and Prevention announced a move yesterday to try to keep the disease off US soil. At the five US airports that receive most passengers from the three countries where Ebola is circulating, passengers will be singled out on the basis of their travel records; interviewed by means of a questionnaire; and have their temperature taken, to see if they have a fever.

It’s the first attempt to control Ebola at the US border, announced, probably coincidentally, on the same day as the death of the only Ebola patient to make it into the US thus far. Political pressure for the CDC to do something was growing, and some visible step was necessary. But in the public health world, I am hearing some doubt whether it will work. Here are some reasons why.
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Keys to Controlling Ebola in the US: Travel Records and Infection Control

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

If you’re at all interested in infectious diseases, you’ve probably heard by now that a person traveled to the United States while infected with Ebola, was diagnosed and is now in a hospital in Texas. (I was on a flight without Wi-Fi yesterday from before the press conference was announced to after it concluded. Turning my phone on after arrival was… interesting.)

The Centers for Disease Control and Prevention held a press conference yesterday afternoon (transcript is here), and WIRED’s Greg Miller covered it.

The quick details:

  • The infected person flew from Liberia to the US on Sept. 19-20 to visit family members who live in Texas.*
  • He began to develop symptoms on Sept. 24 (important because victims are infectious only after symptoms develop).
  • He went to an ER in Dallas on Sept. 26 and was given antibiotics and sent home.
  • Two days later, Sept. 28, he was taken by ambulance to Texas Presbyterian Hospital in Dallas and was admitted on suspicion of Ebola and put in isolation.
  • The test results confirming the diagnosis came down yesterday, the same day as the announcement.

 

(*A quick Google will demonstrate that the patient and his family have been named by the Associated Press, with the New York Times using the name and attributing it to AP. Given the unnecessary panic around Ebola at this point, I have conflicting thoughts about whether and how the name should be used, so am passing on using it for now.)

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The Mathematics of Ebola Trigger Stark Warnings: Act Now or Regret It

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

The Ebola epidemic in Africa has continued to expand since I last wrote about it, and as of a week ago, has accounted for more than 4,200 cases and 2,200 deaths in five countries: Guinea, Liberia, Nigeria, Senegal and Sierra Leone. That is extraordinary: Since the virus was discovered, no Ebola outbreak’s toll has risen above several hundred cases. This now truly is a type of epidemic that the world has never seen before. In light of that, several articles were published recently that are very worth reading.

The most arresting is a piece published last week in the journal Eurosurveillance, which is the peer-reviewed publication of the European Centre for Disease Prevention and Control (the EU’s Stockholm-based version of the US CDC). The piece is an attempt to assess mathematically how the epidemic is growing, by using case reports to determine the “reproductive number.” (Note for non-epidemiology geeks: The basic reproductive number — usually shorted to R0 or “R-nought” — expresses how many cases of disease are likely to be caused by any one infected person. An R0 of less than 1 means an outbreak will die out; an R0 of more than 1 means an outbreak can be expected to increase. If you saw the movie Contagion, this is what Kate Winslet stood up and wrote on a whiteboard early in the film.)

The Eurosurveillance paper, by two researchers from the University of Tokyo and Arizona State University, attempts to derive what the reproductive rate has been in Guinea, Liberia and Sierra Leone. (Note for actual epidemiology geeks: The calculation is for the effective reproductive number, pegged to a point in time, hence actually Rt.) They come up with an R of at least 1, and in some cases 2; that is, at certain points, sick persons have caused disease in two others.

You can see how that could quickly get out of hand, and in fact, that is what the researchers predict. Here is their stop-you-in-your-tracks assessment:

In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014.

That is a jaw-dropping number.
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CDC Director on Ebola: 'The Window of Opportunity Really Is Closing'

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

I said last month that I was going to try to stay out of Ebola news because so much is being written about it elsewhere. Since then, the African outbreak — now really an epidemic, since it is in multiple countries —  has ballooned to 3,000 cases, and the World Health Organization has predicted it may take 6 months or more to bring it under control.

Something caught my attention today though that felt worth highlighting. Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention, gave a lengthy press conference immediately after returning to the US from a visit to the Ebola zone. Frieden has shown in the past that he knows how to be outspoken in a very strategic way; yet even so, the urgency of his language, and his call for an immediate, comprehensive global response, was striking.

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Ebola in Africa and the U.S.: A Curation

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Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

I’ve stayed out of the Ebola news so far, for a couple of reasons. First, as longtime readers know, I’m writing a book; I’m in the last 6 months of it and the work is intense and involves a lot of travel. I’m not always available at the exact moment news breaks. Second, I try to explore things here that readers may not have heard about elsewhere. The Ebola outbreak has been building in West Africa for a while, but when it was revealed at the end of last week that two American aid workers had caught the disease — and that they were being transported back to the US for treatment — the news and the reaction to it instantly filled every channel. Over the weekend, so much misinformation and outrage got pumped out that it feels as though there’s no way to cut through the noise.

But I have a few thoughts. Start with this: No, I don’t think the two aid workers who are being returned to the US pose any risk at all to the average American, or even the average Atlanta resident. Here’s my marker on that: I’m an Atlanta resident. I live less than 2 miles from the CDC and Emory University (the aid workers are being treated in a special unit housed at Emory on behalf of the CDC; the two institutions are next door to each other). My entire neighborhood and a good part of my various friendship circles are CDC employees, Emory healthcare workers, or both.

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A Patient in Minnesota Has Lassa Hemorrhagic Fever. (Don't Panic.)

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Daliborlev (CC), FLickr

Daliborlev (CC), FLickr

News from the Minnesota Department of Public Health and the Centers for Disease Control and Prevention: A Minnesota traveler returning from Africa has been hospitalized with what the CDC confirms to be Lassa fever, a viral hemorrhagic fever that is often lumped together with Ebola hemorrhagic fever, though they are caused by different organisms.

Given the news from West Africa of the growing Ebola outbreak there — 127 cases including 83 deaths, according to the World Health Organization’s last posted update — I suspect there’s going to be some attention to this case, possibly even some alarm. So, switching from Scary Disease Girl to Scary Disease Killjoy (which is sort of like Phoenix becoming Dark Phoenix, only without any planets blowing up): The Minnesota department says there’s no sign the disease has spread. The CDC says it’s not even likely to have infected passengers on the same airplane.

And if you’re thinking, well, surely this has never happened before, a viral hemorrhagic fever coming to the US via airline: Actually, it’s happened seven times before. And no one caught Lassa from the infected travelers in any of those times — not from sitting next to them, not from living in the same house with them, not from having sex with them. It is a very bad disease. But it is not the threat we like to imagine.

(Sorry to spoil the fun.)

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A New Tick-Borne Illness, and a Plea to Consider the Insects

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A tick’s mouth parts under 40x magnification.

In the summer of 2009, two men from northwest Missouri showed up at Heartland Regional Medical Center in St. Joseph, tucked up against the Kansas border 50 miles north of Kansas City. The men were seriously sick. They had high fevers, fatigue, aches, diarrhea and disordered blood counts: lower than normal amounts of white blood cells, which fight infection, and also lower than normal platelets, cells that control bleeding by helping blood to clot. But they had none of the diseases that were high on the differential diagnosis, the list of possible causes that doctors work their way down as they try to figure out what has gone wrong: no flu, no typhus, no Clostridium difficile, and none of the serious foodborne illnesses — no Salmonella, no Shigella, and no Campylobacter.

The two men had one thing in common, though: About a week before being hospitalized, each remembered, he had been bitten by a tick.

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Lassa fever: Coming to an airport near you

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Out of all the scary diseases, none seem to make people horripillate quite as much as the viral hemorrhagic fevers: Ebola, Lassa, Marburg and the rest. That might be due to their still-murky origins, crossing over from the edges of the world of animals into the infringing habitats of men. It might be their uncomfortable classification in biosafety level 4, reserved for life-threatening infections that spread by fine exhaled aerosols and for which there is no vaccine and no treatment. (Four is the highest level. There is no 5.) Probably it is due in part to the enduring impact of the 15-year-old book The Hot Zone by Richard Preston, which in its early pages conducts a master class in describing truly revolting symptoms:

He is holding an airsickness bag over his mouth. He coughs a deep cough and regurgitates something into the bag. The bag swells up. Perhaps he glances around, and then you see that his lips are smeared with something slippery and red, mixed with black specks, as if he has been chewing coffee grounds. His eyes are the color of rubies, and his face is an expressionless mass of bruises. The red spots, which a few days before had started out as starlike speckles, have expanded and merged into huge, spontaneous purple shadows: his whole head is turning black-and-blue.

The cultural response to the viral hemorrhagic fevers has always struck me as interesting. They’re terrifying, and yet we love to hear about them, in a Scary Stories to Tell in the Dark kind of way. When I’ve asked people why the fascination (because I, myself, am much more frightened of parasites, thanks to Carl Zimmer. And brain amoebas), they usually say back to me that it feels like a don’t-leave-the-campfire fright, a safe fright — because, you know, Ebola is over there somewhere. It’s not like it’s coming here.

The problem with that is that VHFs do come here. Actively infectious VHF has been diagnosed in the United States at least six times — most recently in January, in Philadelphia.

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