An Ebola Epidemic Will Not Happen in the U.S.

USA Today features a
slightly alarming headline:
Ebola Only an Plane Ride Away from USA. Of course that is true,
but that does presage the possibililty of a widespread epidemic
here? No. Why not? Because my fellow Americans would go seek
treatment when they feel ill and would submit to quarantine if
diagnosed with the disease. Contrast this with how the New York
Times
reported some West Africans are sadly confusing correlation
with causation:

Eight youths, some armed with slingshots and machetes, stood
warily alongside a rutted dirt road at an opening in the high
reeds, the path to the village of Kolo Bengou. The deadly
Ebola virus is believed to have infected several people in the
village, and the youths were blocking the path to prevent health
workers from entering.

“We don’t want any visitors,” said their leader, Faya
Iroundouno, 17, president of Kolo Bengou’s youth league. “We don’t
want any contact with anyone.” The others nodded in agreement and
fiddled with their slingshots.

Singling out the international aid group Doctors Without
Borders, Mr. Iroundouno continued, “Wherever those people have
passed, the communities have been hit by illness.”

Health workers here say they are now battling two enemies: the
unprecedented Ebola epidemic, which has killed more than 660
people in four countries since it was first detected in March, and fear, which
has produced growing hostility toward outside help. On Friday
alone, health authorities in Guinea confirmed 14 new cases of the
disease.

Workers and officials, blamed by panicked populations for
spreading the virus, have been threatened with knives, stones and
machetes, their vehicles sometimes surrounded by hostile mobs. Log
barriers across narrow dirt roads block medical teams from reaching
villages where the virus is suspected. Sick and dead villagers, cut
off from help, are infecting others.

“This is very unusual, that we are not trusted,” said Marc
Poncin, the emergency coordinator in Guinea for Doctors Without
Borders, the main group fighting the disease here. “We’re not
stopping the epidemic.”

Efforts to monitor it are grinding to a halt because of
“intimidation,” he said. People appear to have more confidence in
witch doctors.

Despite the scary headline, the USA Today article does
note:

Yet while Ebola is a fearsome disease, the virus “would not pose
a major public health risk” in the USA, [Michael] Osterholm,
[director of the Center for Infectious Disease Research and Policy
at the University of Minnesota] says.

That’s because people need to be in intimate contact to spread
the virus, Osterholm says.

Ebola is actually much harder to spread than respiratory
infections, such as influenza or measles. Those viruses pose a much
greater threat on a plane or in any confined space, says Osterholm,
who notes that people cannot spread the Ebola virus simply by
sneezing or coughing.

Ebola also can only be spread by people with active symptoms,
[Stephan] Monroe, [deputy director of the CDC’s national center for
emerging and zoonotic infectious diseases] says.

“No Ebola cases have been reported in the United States and the
likelihood of this outbreak spreading outside of West Africa is
very low,” says Monroe, who says that the CDC has sent 12 experts
to Africa to help with the crisis. “While it’s possible that
someone could become infected with Ebola in Africa” before boarding
a plane to the USA, “it’s very unlikely that they would spread it
to other passengers.”

Ebola does spread readily through body fluids, such as blood and
saliva, Osterholm says. On a plane, a sick person could potentially
contaminate the bathroom if he or she vomits or has diarrhea…

Hospitals in the USA are on high alert for Ebola, however, and
would quickly isolate anyone with suspicious symptoms who has
recently returned from Africa, Osterholm says.

“Right now, we’d have to assume every case is an Ebola case,” in
people with suspicious symptoms, Osterholm says.

In a worst-case scenario, Osterholm says, a handful of emergency
room workers could be exposed before a sick person is
diagnosed.

That being said, if you’ve traveled to West Africa recently and
begin to experience fever, muscle aches, chills, sore throat,
vomiting and diarrhea, a rash and start bleeding all over the place
– go see a doctor.

For more background, see my 2003 column, “Disease,
Public Health, and Liberty,” analyzing when quarantine is
appropriate.